NPIMap

Organization Active NPI

Edgerton Hospital and Health Services Inc

  • Podiatrist
  • Edgerton, WI
National Provider Identifier
1083310908
Registry record updated May 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PodiatristTaxonomy code 213E00000X
Legal business name
EDGERTON HOSPITAL AND HEALTH SERVICES INC
Practice address
111 W Fulton St
Edgerton, WI 53534-1876
Phone
(608) 884-3441
NPI assigned
Feb 2, 2023
Last updated
May 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 24, 2024

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

Authorized official

Name
Charles Roeder
Title
Cfo
Phone
(608) 884-3441

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Psychologist 103T00000X NU
Cardiovascular Disease Physician 207RC0000X NU
Endocrinology, Diabetes & Metabolism Physician 207RE0101X NU
Interventional Cardiology Physician 207RI0011X NU
Pulmonary Disease Physician 207RP1001X NU
Otolaryngology Physician 207Y00000X NU
Psychiatry Physician 2084P0800X NU
Surgery Physician 208600000X NU
Podiatrist 213E00000X NU Primary
Sleep Medicine (Internal Medicine) Physician 207RS0012X NU

Addresses

Primary practice location

111 W Fulton St
Edgerton, WI 53534-1876

Mailing address

11101 N Sherman Rd
Edgerton, WI 53534-9002
Phone (608) 884-3441

Other names 1

  • Edgerton Hospital and Health Services Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040304000743 WI Part B Supplier - Clinic/Group Practice 7719874502 Receives reassigned benefits from 96 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Edgerton, WI; Milton, WI; Whitewater, WI

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 20

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 20

NPI Registry JSON

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

{
    "created_epoch": "1675296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716508800000",
    "number": "1083310908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11101 N SHERMAN RD",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535349002",
            "telephone_number": "608-884-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 W FULTON ST",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341876",
            "telephone_number": "608-884-3441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGERTON HOSPITAL AND HEALTH SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-02-02",
        "last_updated": "2024-05-24",
        "certification_date": "2024-05-24",
        "status": "A",
        "authorized_official_last_name": "ROEDER",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "608-884-3441"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgerton Hospital and Health Services",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Edgerton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2024; 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.