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Agnesian Healthcare Inc

Organization Active NPI Community/Retail Pharmacy · Fond Du Lac, WI

NPI 1104891746 · NPPES record last updated Jul 23, 2025

Key facts

NPI
1104891746
Entity type
Organization (NPI type 2)
Primary specialty
Community/Retail Pharmacy 3336C0003X
Legal business name
AGNESIAN HEALTHCARE INC
Practice address
145 N Main St
Fond Du Lac, WI 54935-3423
Phone
(920) 926-4660
Fax
(920) 922-5011
NPI assigned
Feb 17, 2006
Organization subpart
No

Authorized official

Name
Amy Jo Grinnell
Title
Finance Vice President Wi Region
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 on the same Medicare enrollment 3

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

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 (2 enrollments) 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
O20250213002665 WI Part B Supplier - Mass Immunization (Roster Biller Only) 1658289624 3 other NPIs on this enrollment
Practice locations: Fond Du Lac, WI; Waupun, WI
O20250514001076 WI DME Supplier - Pharmacy 1658289624 Practice locations: Fond Du Lac, WI

National Provider Directory

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

Locations

145 N Main St
Fond du Lac, WI 54935
Phone (920) 926-4660

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Yes

Addresses

Primary practice location

145 N Main St
Fond Du Lac, WI 54935-3423

Mailing address

145 N Main St
Fond Du Lac, WI 54935-3423
Phone (920) 921-4660

Other identifiers

IdentifierTypeStateIssuer
100307261MedicaidWI
2109968OtherPK
33259200MedicaidWI

Other names

  • SSM Health Pharmacy Doing business as

Other providers in Fond Du Lac, WI

All providers in Fond Du Lac, WI · Community/Retail Pharmacy in Wisconsin

Sources for this page

Verify at the official NPI Registry.