Thedacare Medical Center - Berlin, Inc.
Organization Active NPI Community/Retail Pharmacy · Berlin, WI
NPI 1043072291 · NPPES record last updated Jun 14, 2024
Key facts
- NPI
- 1043072291
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community/Retail Pharmacy 3336C0003X
- Legal business name
- THEDACARE MEDICAL CENTER - BERLIN, INC.
- Practice address
- 225 Memorial Dr
Berlin, WI 54923-1243 - Phone
- (920) 291-5768
- NPI assigned
- Jan 24, 2024
- Organization subpart
- No
Authorized official
- Name
- William Flett
- Title
- Cfo
- Phone
- (920) 454-4013
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 11
Practitioners 102
-
Brice Alvord, M.D.
-
Erik J Amoroso, M.D.
-
Jennifer Marie Bahr, M.D.
-
Christopher Bender, D.O.
-
Joseph S Brantman, M.D.
-
David Budde, DO
-
Andrew W Calvert, MD
-
Chandler D Caves, MD
-
Joshua X Condado, CRNA
-
Ismail A Dania, MD
-
Samuel J Docksey, DO
-
Erin K Eferem, M.D.
-
Dennis D Ford, MD
-
Julie R Fredrick, APNP
-
Jason Landon Garrow, P.A.
-
Cally F Gordon-Haessly, PA-C
-
Logan Robert Gorges, M.D.
-
Danielle E Greve, APNP
-
David B Hale, MD
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| Thedacare Medical Center - Berlin I |
Epoetin|Immunosuppressive Drugs|Infusion Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240812000919 | WI | Part B Supplier - Pharmacy | 0446151666 | Practice locations: Berlin, WI |
| O20250106001891 | WI | DME Supplier - Pharmacy | 0446151666 | Practice locations: Berlin, WI |
National Provider Directory
- Tax ID family
- CHN Lifeskills
Locations
225 Memorial Dr
Ste 1200
Berlin, WI 54923
Phone (920) 361-5770
N6205 Busse Rd
Green Lake, WI 54941
Phone (920) 294-3444
402 Preston Ln
Redgranite, WI 54970
Phone (920) 361-5555
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | Yes |
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
- ThedaCare Remote Dispensing Site-Berlin
Other providers in Berlin, WI
- Supportive Learning Care
- Tina Lorene Swanke
- Lisa Ann Taylor
- Alyssa Marie Tessaro
- Thedacare Medical Center - Berlin, Inc.
- Thedacare Medical Center - Berlin, Inc.
- Thedacare Medical Center - Berlin, Inc.
- Thedacare Medical Center - Berlin, Inc.
- Thedacare Medical Center Berlin
- Thedacare Medical Center-Berlin, Inc.
All providers in Berlin, WI · Community/Retail Pharmacy in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.