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AFFILIATED HEALTH OF WISCONSIN LTD.
NPI 1063433977
Physical Medicine & Rehabilitation - Pain Medicine in Wauwatosa, WI

Active since July 23, 2006CLIA 52D2091830 · Waiver
2626 N 76TH ST, SUITE 105, WAUWATOSA, WI 53213(414) 774-7794(414) 607-3971 Get Directions Write a Review

NPPES record last updated: August 25, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Affiliated Health Of Wisconsin Ltd. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AFFILIATED HEALTH OF WISCONSIN LTD. (NPI 1063433977) is a healthcare organization registered as a pain medicine in Wauwatosa, Wisconsin and active in the NPI registry since July 2006. The organization holds a CLIA Waiver certificate valid through February 19, 2027 and lists Jay L Mackman, Director, as its authorized official.

NPPES Registry Identity

NPI1063433977
Entity TypeOrganization
Primary Taxonomy2081P2900X
Legal Business NameAFFILIATED HEALTH OF WISCONSIN LTD.
Location Address2626 N 76TH ST, SUITE 105Wauwatosa, WI 53213-1137
Mailing Address2626 N 76th St, Suite 105Wauwatosa, WI 53213-1137 · (414) 774-7794 · Fax (414) 607-3971
Phone(414) 774-7794
Fax(414) 607-3971
Organization SubpartNo
Authorized OfficialJay L MackmanDirector · (414) 476-9400
Enumeration DateJuly 23, 2006
Last NPPES UpdateAugust 25, 2023
NPPES CertifiedAugust 25, 2023
✔ NPI 1063433977 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyPhysical Medicine & Rehabilitation · Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2081P2900X
Definition
A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists.
Also ListedPhysical TherapistTaxonomy 225100000X
Also ListedRadiologic Technologist · Computed TomographyTaxonomy 2471C3401X
Also ListedPhysician AssistantTaxonomy 363A00000X
2626 N 76TH ST, Wauwatosa, WI 53213
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), Network Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Affiliated Health Of Wisconsin Ltd. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

3

Medicare enrollment records show 3 clinicians reassign Medicare billing to Affiliated Health Of Wisconsin Ltd., which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.

Clinicians, nearest first (3)

Jacob Raml, DPT
Physical Therapist in Private Practice
NPI 1740709187
2626 N 76TH ST STE 105
Wauwatosa, WI 53213
(414) 774-7794
Same address
Sam Goldner, DPT
Physical Therapist in Private Practice
NPI 1679203582
2626 N 76TH ST # 101
Wauwatosa, WI 53213
(414) 476-9400
✔ Accepts Medicare4.9 mi
Mary Billerbeck
Physical Therapist in Private Practice
NPI 1427867449
414 WILLIAM ST
Racine, WI 53402
(262) 497-9147
✔ Accepts Medicare24 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2091830

Affiliated Health Of Wisconsin · Wauwatosa, WI
Active · expires Feb 19, 2027
CLIA Number52D2091830
Laboratory TypePhysician Office
Certificate Effective DateFebruary 20, 2025
Certificate Expiration DateFebruary 19, 2027
Laboratory DirectorDr. Connor M. Peck
Laboratory Phone(414) 771-2707
Laboratory LocationAffiliated Health Of Wisconsin2626 N 76th St, Suite 105, Wauwatosa, WI 53213
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Affiliated Health Of Wisconsin Ltd.'s NPI number?

The NPI number for Affiliated Health Of Wisconsin Ltd. is 1063433977. It was assigned to this organization in the NPPES registry on July 23, 2006.

Where is Affiliated Health Of Wisconsin Ltd. located?

Affiliated Health Of Wisconsin Ltd. is located at 2626 N 76th St Suite 105, Wauwatosa, WI 53213. The listed phone number is (414) 774-7794.

What is Affiliated Health Of Wisconsin Ltd.'s specialty?

The primary specialty registered for this NPI is Physical Medicine & Rehabilitation, specializing in Pain Medicine, with taxonomy code 2081P2900X.

Is Affiliated Health Of Wisconsin Ltd. enrolled in Medicare?

Yes. Affiliated Health Of Wisconsin Ltd. is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Affiliated Health Of Wisconsin Ltd.?

According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians, all in Physical Therapist in Private Practice, reassign their Medicare billing to Affiliated Health Of Wisconsin Ltd.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Affiliated Health Of Wisconsin Ltd. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2091830) is associated with this NPI, valid through February 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Affiliated Health Of Wisconsin Ltd. accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare) and Network Health list Affiliated Health Of Wisconsin Ltd. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Affiliated Health Of Wisconsin Ltd. was last updated on August 25, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.