NPIMap

Organization Active NPI

Agnesian Healthcare, Inc

Doing business as St Agnes Hospital Home Infusion

  • Home Infusion Therapy Pharmacy
  • Fond Du Lac, WI
National Provider Identifier
1114992492
Registry record updated Jun 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Infusion Therapy PharmacyTaxonomy code 3336H0001X
Legal business name
AGNESIAN HEALTHCARE, INC
Doing business as
St Agnes Hospital Home Infusion
Practice address
430 E Division St
Fond Du Lac, WI 54935-4560
Phone
(920) 926-4666
NPI assigned
Feb 21, 2006
Last updated
Jun 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2024

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Infusion Agency 251F00000X NU
Home Infusion Therapy Pharmacy 3336H0001X NU Primary

Addresses

Primary practice location

430 E Division St
Fond Du Lac, WI 54935-4560

Mailing address

430 E Division St
PO Box 385
Fond Du Lac, WI 54935-4560
Phone (920) 926-4472

Other identifiers 1

IdentifierTypeStateIssuer
33255500MedicaidWI

Other names 1

  • St Agnes Hospital Home Infusion Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930046701 WI DME Supplier - PharmacyDME Supplier - Hospital 1658289624 Practice locations: Fond Du Lac, WI

Other NPIs with the same Medicare PAC ID 16

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

View all 16

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.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Agnesian Healthcare Inc430 E Division St, Fond Du Lac, WI 54935-4560(920) 926-4653 Infusion Drugs|External Infusion Pumps and/or Supplies|Parenteral Nutrients|Parenteral Equipment and/or Supplies Accepts assignmentParticipating since Jan 1, 1998

National Provider Directory

National Provider Directory
Tax ID family
Agnesian Healthcare27 organizations share this tax ID, including this one

Other organizations with this 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.

Ownership & related parties

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

Owned or controlled facilities with NPI records 4

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

NPI Registry JSON

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717545600000",
    "number": "1114992492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "address_2": "PO BOX 385",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-4472",
            "fax_number": "920-926-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-4666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-21",
        "last_updated": "2024-06-05",
        "certification_date": "2024-06-05",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "VP-FINANCE, CFO",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "251F00000X",
            "taxonomy_group": "",
            "desc": "Home Infusion",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3336H0001X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Home Infusion Therapy Pharmacy",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33255500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St Agnes Hospital Home Infusion",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Agnes Hospital Home Infusion",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.