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Agnesian Healthcare Inc

Organization Active NPI Durable Medical Equipment & Medical Supplies · Ripon, WI

NPI 1073842571 · NPPES record last updated Jun 5, 2024

Key facts

NPI
1073842571
Entity type
Organization (NPI type 2)
Primary specialty
Durable Medical Equipment & Medical Supplies 332B00000X
Legal business name
AGNESIAN HEALTHCARE INC
Practice address
790 Eastgate Dr
Ripon, WI 54971-9614
Phone
(920) 745-3180
NPI assigned
Dec 11, 2009
Organization subpart
No

Authorized official

Name
Amy Grinnell
Title
VP-Finance, Cfo
Phone
(608) 260-3586

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs with the same Medicare PAC ID 16

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

Corporate family (same tax ID) 26

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

View all 26

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners 392

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

View all 392

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
SSM Health Waupun Memorial Hospital
Waupun, WI · CCN 52Z327		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2000
SSM Health Ripon Community Hospital
Ripon, WI · CCN 521321		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2011
SSM Health Ripon Community Hospital
Ripon, WI · CCN 52Z321		 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2011
St Francis Home
Fond Du Lac, WI · CCN 525595		 Skilled nursing facility Operational/Managerial Control Jun 1, 1978

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20100930044660 WI DME Supplier - Multi-Specialty - Physician 1658289624 Practice locations: Ripon, WI

National Provider Directory

Tax ID family
Fond Du Lac Regional CL (27 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Yes

Addresses

Primary practice location

790 Eastgate Dr
Ripon, WI 54971-9614

Mailing address

1808 W Beltline Hwy
Madison, WI 53713-2334
Phone (608) 250-1593

Other names

  • SSM HEALTH FOND DU LAC REGIONAL CLINIC Doing business as

Other providers in Ripon, WI

All providers in Ripon, WI · Durable Medical Equipment & Medical Supplies in Wisconsin

Sources for this page

Verify at the official NPI Registry.