NPIMap

Organization Active NPI

New Medical Center, S.C.

  • General Practice Physician
  • Waupun, WI
National Provider Identifier
1093368607
Registry record updated May 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
NEW MEDICAL CENTER, S.C.
Practice address
160 Gateway Dr, Ste a
Waupun, WI 53963-2276
Phone
(920) 324-9899
Fax
(920) 324-9898
NPI assigned
Jul 23, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2022

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

Authorized official

Name
Dr. Randall L Blohowiak, DCNPI 1356301188
Title
President
Phone
(920) 324-9899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

160 Gateway Dr, Ste a
Waupun, WI 53963-2276

Mailing address

160 Gateway Dr, Ste a
Waupun, WI 53963-2276
Phone (920) 324-9899

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20191114000095 WI Part B Supplier - Clinic/Group Practice 8022440973 Receives reassigned benefits from 7 practitioners
Practice locations: Waupun, WI
O20200330001457 WI DME Supplier - Medical Supply Company 8022440973 Practice locations: Waupun, WI

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.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2269416New Medical Center160 Gateway Dr, Waupun, WI 53963Certificate of waiverSep 25, 2026

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
New Medical Center, SC160 Gateway Dr, Waupun, WI 53963-2276(920) 324-9899 Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf Accepts assignmentParticipating since Sep 28, 2019

National Provider Directory

National Provider Directory

Locations

160 Gateway Dr
Ste A
Waupun, WI 53963
Phone (920) 324-9899

Practitioners & affiliated clinicians

Practitioners 7

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

NPI Registry JSON

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

{
    "created_epoch": "1563840000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651708800000",
    "number": "1093368607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR, STE A",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899",
            "fax_number": "920-324-9898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR, STE A",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899",
            "fax_number": "920-324-9898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MEDICAL CENTER, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-23",
        "last_updated": "2022-05-05",
        "certification_date": "2022-05-05",
        "status": "A",
        "authorized_official_last_name": "BLOHOWIAK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-324-9899",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2022; 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.