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DR. ANNALIESE MARIE KOLLER SHUMATE D.O.
NPI 1174812499
General Practice in Wauwatosa, WI

Active since April 07, 2011PECOS Enrolled
1155 N MAYFAIR RD, 3RD FLOOR, DEPARTMENT OF PSYCHIATRY, WAUWATOSA, WI 53226(414) 955-8990 Get Directions Write a Review

NPPES record last updated: October 17, 2013. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Annaliese Marie Koller Shumate D.o. NPPES

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

DR. ANNALIESE MARIE KOLLER SHUMATE D.O. (NPI 1174812499) is an individual general practice provider in Wauwatosa, Wisconsin, licensed in Wisconsin (60433-21) and active in the NPI registry since April 2011. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1174812499
Entity TypeIndividualFemale
Primary Taxonomy208D00000X
Provider Legal NameDR. ANNALIESE MARIE KOLLER SHUMATECredential: D.O.
Location Address1155 N MAYFAIR RD, 3RD FLOOR, DEPARTMENT OF PSYCHIATRYWauwatosa, WI 53226-3462
Mailing Address1155 N Mayfair Rd, 3rd Floor, Department Of PsychiatryWauwatosa, WI 53226-3462 · (414) 955-8990
Phone(414) 955-8990
Sole ProprietorNo
Enumeration DateApril 7, 2011
Last NPPES UpdateOctober 17, 2013
✔ NPI 1174812499 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in WI · 60433-21
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
1155 N MAYFAIR RD, Wauwatosa, WI 53226
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Annaliese Marie Koller Shumate D.o. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Annaliese Koller Shumate reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

County Of Milwaukee
6.1 mi
Psychiatry
1220 W VLIET ST FL 3
Milwaukee, WI 53205
  • Reassigned Medicare billing, Wisconsin enrollment
  • 12 clinicians in this Medicare group
NPI 1831256353 (414) 257-6995

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

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KEVIN BOZYMSKI PHARMD, BCPS
Pharmacist (Psychiatric)
1155 N MAYFAIR RD
MILWAUKEE, WI 53226
Milwaukee County (414) 955-8950
STEVEN BONDOW MD
Family Medicine
1155 N MAYFAIR RD, PLANK ROAD CLINIC
MILWAUKEE, WI 53226
Milwaukee County (414) 955-5990
MR. STEVEN C. MAJSTORAVICH PTA
Physical Therapy Assistant
1155 N MAYFAIR RD
MILWAUKEE, WI 53226
Milwaukee County (414) 805-3666
DR. SABINA DIEHR MD
Family Medicine
1155 N MAYFAIR RD, PLANK ROAD CLINIC
MILWAUKEE, WI 53226
Milwaukee County (414) 955-5990
DR. CHRISTOPHER E WOLFLA MD
Neurological Surgery
1155 N MAYFAIR RD, SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI 53226
Milwaukee County (414) 805-9255
DR. PHILIP A NELSON MD
Physical Medicine & Rehabilitation
1155 N MAYFAIR RD, SPINE CARE CLINIC AT PLANK ROAD
MILWAUKEE, WI 53226
Milwaukee County (414) 456-7199
DR. MICHAEL DIMARCO JR. PSY.D.
Psychologist (Clinical)
1155 N MAYFAIR RD, THIRD FLOOR
MILWAUKEE, WI 53226
Milwaukee County (414) 955-8900
MR. JOSEPH S. GOVEAS M.D.
Psychiatry & Neurology (Psychiatry)
1155 N MAYFAIR RD, DEPARTMENT OF PSYCHIATRY
MILWAUKEE, WI 53226
Milwaukee County (414) 955-8900

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 Annaliese Koller Shumate's NPI number?

The NPI number for Annaliese Koller Shumate is 1174812499. It was assigned to this individual provider in the NPPES registry on April 7, 2011.

Where is Annaliese Koller Shumate located?

Annaliese Koller Shumate practices at 1155 N Mayfair Rd 3rd Floor, Department Of Psychiatry, Wauwatosa, WI 53226. The listed phone number is (414) 955-8990.

What is Annaliese Koller Shumate's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

Is Annaliese Koller Shumate enrolled in Medicare?

Yes. Annaliese Koller Shumate is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Annaliese Koller Shumate's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Annaliese Koller Shumate reassigns Medicare benefits to County Of Milwaukee (Milwaukee, WI). The 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 Annaliese Koller Shumate's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Annaliese Koller Shumate was last updated on October 17, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.