NPIMap

Organization Active NPI

Thedacare Medical Center - Berlin, Inc.

Doing business as ThedaCare Remote Dispensing Site-Berlin

  • Community/Retail Pharmacy
  • Berlin, WI
National Provider Identifier
1043072291
Registry record updated Jun 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
THEDACARE MEDICAL CENTER - BERLIN, INC.
Doing business as
ThedaCare Remote Dispensing Site-Berlin
Practice address
225 Memorial Dr
Berlin, WI 54923-1243
Phone
(920) 291-5768
NPI assigned
Jan 24, 2024
Last updated
Jun 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

225 Memorial Dr
Berlin, WI 54923-1243

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 454-4229

Other names 1

  • ThedaCare Remote Dispensing Site-Berlin Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20240812000919 WI Part B Supplier - Pharmacy 0446151666 Practice locations: Berlin, WI
O20250106001891 WI DME Supplier - Pharmacy 0446151666 Practice locations: Berlin, WI

Other NPIs with the same Medicare PAC ID 2

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

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Thedacare Medical Center - Berlin I225 Memorial Dr, Berlin, WI 54923-1243(920) 291-5768 Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
CHN Lifeskills12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

215 Church St
Montello, WI 53949
Phone (608) 297-2626

Practitioners & affiliated clinicians

Practitioners 102

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 102

NPI Registry JSON

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

{
    "created_epoch": "1706054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718323200000",
    "number": "1043072291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-454-4229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEMORIAL DR",
            "city": "BERLIN",
            "state": "WI",
            "postal_code": "549231243",
            "telephone_number": "920-291-5768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - BERLIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-24",
        "last_updated": "2024-06-14",
        "certification_date": "2024-06-14",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ThedaCare Remote Dispensing Site-Berlin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ThedaCare Remote Dispensing Site-Berlin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berlin, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.