NPIMap

Organization Active NPI

Winneshiek Medical Center

Doing business as Winneshiek Medical Center Anesthesia

  • Certified Registered Nurse Anesthetist
  • Decorah, IA
National Provider Identifier
1023022803
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
WINNESHIEK MEDICAL CENTER
Doing business as
Winneshiek Medical Center Anesthesia
Practice address
901 Montgomery St
Decorah, IA 52101-2325
Phone
(952) 442-9770
NPI assigned
Jul 28, 2006
Last updated
Jul 25, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Authorized official

Name
Lisa M. Radtke
Title
Cao
Phone
(563) 387-3145

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

901 Montgomery St
Decorah, IA 52101-2325

Mailing address

400 E 10TH St
Waconia, MN 55387-4552
Phone (952) 442-9770

Other identifiers 3

IdentifierTypeStateIssuer
869T2WIOtherMNBLUE CROSS OF MN
0736561MedicaidIA
23199OtherIABLUE CROSS OF IOWA

Other names 1

  • WINNESHIEK MEDICAL CENTER ANESTHESIA Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040316001437 IA Part B Supplier - Clinic/Group Practice 4688582935 Receives reassigned benefits from 178 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Decorah, IA; West Union, IA; Ossian, IA; Fayette, IA; Cresco, IA

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564012800000",
    "number": "1023022803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 10TH ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 MONTGOMERY ST",
            "city": "DECORAH",
            "state": "IA",
            "postal_code": "521012325",
            "telephone_number": "952-442-9770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINNESHIEK MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-28",
        "last_updated": "2019-07-25",
        "status": "A",
        "authorized_official_last_name": "RADTKE",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "563-387-3145"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MN",
            "identifier": "869T2WI",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0736561",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF IOWA",
            "identifier": "23199",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WINNESHIEK MEDICAL CENTER ANESTHESIA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WINNESHIEK MEDICAL CENTER ANESTHESIA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Decorah, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.