NPIMap

Organization Active NPI

Thedacare Medical Center - New London, Inc.

  • Critical Access Hospital
  • Clintonville, WI
National Provider Identifier
1144675745
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1029 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - NEW LONDON, INC.
Practice address
370 S Main St
Clintonville, WI 54929-1632
Phone
(920) 830-5900
Fax
(920) 830-5910
NPI assigned
May 2, 2016
Organization subpart
Yes
Parent organization
THEDACARE MEDICAL CENTER - NEW LONDON, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
Mr. William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 1029 WI Primary

Addresses

Primary practice location

370 S Main St
Clintonville, WI 54929-1632

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other identifiers 1

IdentifierTypeStateIssuer
521326OtherWIMEDICARE PTAN

Other names 1

  • NEW LONDON FAMILY MEDICAL CENTER, INC Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20161208000919 WI Part A Provider - Critical Access Hospital 5698664480 Receives reassigned benefits from 54 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Clintonville, WI; New London, WI

Hospital certification: CCN 521326

Legal name
THEDACARE MEDICAL CENTER - NEW LONDON, INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2003
Last certification
Aug 24, 2016
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 28, 1930 in WI
Enrollment address
1405 Mill St
New London, WI 54961-2155

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Thedacare Medical Center - New LondonCCN 521326
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
New London FM Med Ctr

Ownership & related parties

All disclosed owners & managing parties 14

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Froedtert Thedacare Health, Inc. Organization, Milwaukee, WI Corporation, Non-profit Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing EmployeeDirector, Payer Contracting Jan 1, 2023
Laurie a Carter Individual Corporate DirectorBoard Member Jan 1, 2024
Thedacare, Incorporated Organization, Neenah, WI Non-profit Operational/Managerial Control Jan 1, 2000
Mary W Goggans Individual Corporate DirectorBoard Member Jan 1, 2024
Alan Loux Individual Corporate Director Jan 1, 2024
William Flett Individual Corporate DirectorCfo Oct 31, 2023
W-2 Managing EmployeeAuthorized Official Oct 31, 2023
Imran a Andrabi Individual Corporate OfficerCeo-President Jun 28, 2017
W-2 Managing Employee Jun 28, 2017
Chuck Dallas Individual Corporate DirectorBoard Member Jan 1, 2024
David W Koeper Individual Corporate DirectorBoard Member Jan 1, 2024
Susan M Pahl Individual W-2 Managing EmployeeDelegated Official Jan 1, 2023
Steven J Price Individual Corporate Director Jan 1, 2024
Kathleen Pigeon Individual W-2 Managing EmployeeDelegated Official Jun 11, 2000
Michael Morse Individual Corporate DirectorBoard Member Jan 1, 2022

Owners & managing parties with NPI records 14

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

View all 14

Practitioners & affiliated clinicians

Practitioners 48

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

View all 48

Affiliated clinicians 169

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 169

NPI Registry JSON

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

{
    "created_epoch": "1462147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1144675745",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 S MAIN ST",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549291632",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - NEW LONDON, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THEDACARE MEDICAL CENTER - NEW LONDON, INC.",
        "enumeration_date": "2016-05-02",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "1029",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "521326",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NEW LONDON FAMILY MEDICAL CENTER, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "NEW LONDON FAMILY MEDICAL CENTER, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Clintonville, WI

Sources for this page

Verify at the official NPI Registry.