NPIMap

Organization Active NPI

SSM Health Care of Wisconsin, Inc.

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Baraboo, WI
National Provider Identifier
1053392845
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
SSM HEALTH CARE OF WISCONSIN, INC.
Practice address
1600 Jefferson St
Baraboo, WI 53913-1542
Phone
(608) 356-1400
NPI assigned
Nov 8, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Authorized official

Name
Joseph R Minerath
Title
System Director - Gov'T Reimb.
Phone
(608) 445-2411

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

1600 Jefferson St
Baraboo, WI 53913-1542

Mailing address

1802 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 217-8446

Other identifiers 5

IdentifierTypeStateIssuer
11022800MedicaidWI
572292OtherWIDEANCARE VENDOR #
391023846OtherWICOMMERCIAL INS PROV #
1009390OtherWIPHYS PLUS PROV #
391023846028OtherWIBLUE CROSS PROV #

Other names 1

  • St Clare Dialysis Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1131408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1672790400000",
    "number": "1053392845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1802 W BELTLINE HWY",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132334",
            "telephone_number": "608-217-8446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 JEFFERSON ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131542",
            "telephone_number": "608-356-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM HEALTH CARE OF WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-08",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A",
        "authorized_official_last_name": "MINERATH",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SYSTEM DIRECTOR - GOV'T REIMB.",
        "authorized_official_telephone_number": "608-445-2411"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11022800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEANCARE VENDOR #",
            "identifier": "572292",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INS PROV #",
            "identifier": "391023846",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYS PLUS PROV #",
            "identifier": "1009390",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV #",
            "identifier": "391023846028",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Clare Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Clare Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Baraboo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.