NPIMap

Organization Active NPI

Froedtert South, Inc.

  • General Acute Care Hospital
  • Pleasant Prairie, WI
National Provider Identifier
1003831132
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
52-0021 Issued in WI
Legal business name
FROEDTERT SOUTH, INC.
Practice address
9555 76TH St
Pleasant Prairie, WI 53158-1984
Phone
(262) 577-8000
Fax
(262) 653-5852
NPI assigned
Jul 12, 2006
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Thomas J Kelley III
Title
VP & Cfo
Phone
(262) 577-8113

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 52-2335 WI
General Acute Care Hospital 282N00000X 52-0021 WI Primary

Addresses

Primary practice location

9555 76TH St
Pleasant Prairie, WI 53158-1984

Mailing address

6308 8TH Ave
Kenosha, WI 53143-5031
Phone (262) 656-2011

Other practice location 1

6308 8th Ave
Kenosha, WI 53143-5031
Phone (262) 656-2011

Other identifiers 1

IdentifierTypeStateIssuer
11007800MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20031103000493 WI Part B Supplier - Clinic/Group Practice 9537071196 Receives reassigned benefits from 260 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Salem, WI; Pleasant Prairie, WI; Kenosha, WI
O20071127000537 WI Part A Provider - Hospital 9537071196 Practice locations: Pleasant Prairie, WI; Salem, WI; Kenosha, WI
O20110114000052 WI Part A Provider - End-Stage Renal Disease Facility (ESRD) 9537071196 Practice locations: Pleasant Prairie, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003831132. Details of each certification follow.

Hospital certification: CCN 520021

Legal name
FROEDTERT SOUTH INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 24, 2003
Beds
380
Ownership / control type
Local
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 1910 in WI
Enrollment address
9555 76TH St
Pleasant Prairie, WI 53158-1984
Main/Primary Hospital Location
Hospital subgroups
Acute care

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Froedtert South ESRD-St. Catherine's Kidney Ctr -CCN 522335
Overall star rating
4.0 of 5
Ownership
Non-profit
Certified
Oct 1, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
21

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Care Compare: Hospital

Medicare Care Compare
Listed as
Froedtert South Inc.CCN 520021 · All quality measures
Overall star rating
2 of 5
Type
Acute Care Hospitals
Ownership
Government - Local
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D1001216Froedtert South-Froedtert Pleasant Prairie9555 76TH St, Pleasant Prairie, WI 53158AccreditationAug 10, 2027

National Provider Directory

National Provider Directory

Locations

9697 Saint Catherines Dr
Pleasant Prairie, WI 53158
Phone (262) 577-8141

Ownership & related parties

All disclosed owners & managing parties 17

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Catherine Jacobson Individual Corporate DirectorBoard Member Oct 1, 2017
Richard O Schmidt Individual Corporate OfficerPresident Nov 14, 2007
Corporate DirectorBoard Member Nov 14, 2007
W-2 Managing EmployeePresident & Ceo Nov 16, 2010
Bryan D Albrecht Individual Corporate DirectorBoard Member Oct 27, 2021
Harold W Mayer Individual Corporate OfficerMember-at-Large Nov 14, 2007
Corporate DirectorBoard Member Nov 14, 2007
Thomas M Ambro Individual Corporate DirectorBoard Member Oct 26, 2016
Michael J Pitts Individual Corporate DirectorBoard Member Apr 25, 2018
Gary J Zaid Individual Corporate DirectorBoard Member Oct 26, 2016
Mark R Behl Individual Corporate DirectorBoard Member Jan 27, 2021
Robert E Lee Individual Corporate OfficerMember-at-Large Oct 21, 2010
Corporate DirectorBoard Member Oct 21, 2010
Thomas J Kelley Individual Corporate OfficerAssistant Treasurer Jul 28, 2011
Corporate DirectorBoard Member Jul 28, 2011
W-2 Managing EmployeeVice President and Cfo Jul 28, 2011
Mario Garretto Individual Corporate DirectorBoard Member Oct 26, 2016
Todd R Battle Individual Corporate DirectorBoard Member Jan 28, 2015
Thomas P Mahoney Individual Corporate DirectorBoard Member Oct 23, 2012
Fenton G Campbell Individual Corporate OfficerChairman Nov 14, 2007
Corporate DirectorBoard Member Nov 14, 2007
Linda S Wohlgemuth Individual Corporate OfficerAssistant Secretary Oct 21, 2010
Corporate DirectorBoard Member Oct 21, 2010
W-2 Managing EmployeeVice President and Coo Oct 21, 2010
Michael G Gentile Individual Corporate OfficerTreasurer Jan 23, 2019
Corporate DirectorBoard Member Jan 23, 2019
David R Riley Individual Corporate DirectorBoard Member Oct 23, 2012

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 110

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 110

Affiliated clinicians 472

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 472

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1003831132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6308 8TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531435031",
            "telephone_number": "262-656-2011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9555 76TH ST",
            "city": "PLEASANT PRAIRIE",
            "state": "WI",
            "postal_code": "531581984",
            "telephone_number": "262-577-8000",
            "fax_number": "262-653-5852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6308 8th Ave",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531435031",
            "country_code": "US",
            "telephone_number": "262-656-2011",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "FROEDTERT SOUTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-12",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "KELLEY",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP & CFO",
        "authorized_official_telephone_number": "262-577-8113",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "WI",
            "license": "52-2335",
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WI",
            "license": "52-0021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11007800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Prairie, WI

Sources for this page

Verify at the official NPI Registry.