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Organization Active NPI

Tomah Memorial Hospital Inc

Doing business as Tomah Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Tomah, WI
National Provider Identifier
1205978046
Registry record updated Sep 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
2049-800 Issued in WI
Legal business name
TOMAH MEMORIAL HOSPITAL INC
Doing business as
Tomah Memorial Hospital
Practice address
501 Gopher Dr
Tomah, WI 54660-4513
Phone
(608) 372-2181
Fax
(608) 377-8737
NPI assigned
Feb 12, 2007
Last updated
Sep 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
TOMAH MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 2, 2025

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

Authorized official

Name
Derek Daly
Title
Ceo
Phone
(608) 372-2181

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 2049-800 WI Primary

Addresses

Primary practice location

501 Gopher Dr
Tomah, WI 54660-4513

Mailing address

501 Gopher Dr
Tomah, WI 54660-4513
Phone (608) 372-2181

Other names 1

  • Tomah Memorial Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20101120000200 WI Part A Provider - Critical Access Hospital 6901897016 Receives reassigned benefits from 1 practitioner
Practice locations: Tomah, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205978046. Details of each certification follow.

Hospital certification: CCN 52Z320

Legal name
TOMAH MEMORIAL HOSPITAL INC
Doing business as
TOMAH HEALTH
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 1948 in WI
Enrollment address
501 Gopher Dr
Tomah, WI 54660-4513
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Tomah Mem Hosp Crnas7 organizations share this tax ID, including this one
Part of
Tomah Mem Hosp Crnas

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

601 Straw St
Tomah, WI 54660
Phone (608) 372-2181

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Robert Holness Individual Corporate DirectorBoard Member Jan 18, 2022
Elizabeth Arity Individual Corporate DirectorBoard Member Jan 17, 2023
Greg Gaarder Individual Corporate DirectorBoard Member Oct 1, 2019
Sue Playter Mubarak Individual Corporate DirectorBoard Member Jan 21, 2020
Deb Buswell Individual Corporate DirectorBoard Member Jan 19, 2021
Brian Scott Nicol Individual Corporate DirectorBoard Member Jan 18, 2022
Wesley D Revels Individual Corporate DirectorBoard Member Jan 17, 2023
Derek Daly Individual Corporate DirectorCeo Aug 1, 2022
Keith Laugen Individual Corporate DirectorBoard Member Jan 16, 2018
Joseph P Zeps Individual Corporate OfficerChief Financial Officer Mar 28, 2006
W-2 Managing EmployeeChief Financial Officer Mar 28, 2006
Tiffany Casper Individual Corporate DirectorBoard Member Jan 17, 2023

Owners & managing parties with NPI records 2

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 267

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 267

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1171238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1756771200000",
    "number": "1205978046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 GOPHER DR",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546604513",
            "telephone_number": "608-372-2181",
            "fax_number": "608-377-8737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 GOPHER DR",
            "city": "TOMAH",
            "state": "WI",
            "postal_code": "546604513",
            "telephone_number": "608-372-2181",
            "fax_number": "608-377-8737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOMAH MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TOMAH MEMORIAL HOSPITAL INC",
        "enumeration_date": "2007-02-12",
        "last_updated": "2025-09-02",
        "certification_date": "2025-03-28",
        "status": "A",
        "authorized_official_last_name": "DALY",
        "authorized_official_first_name": "DEREK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "608-372-2181"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WI",
            "license": "2049-800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tomah Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Tomah, WI

Sources for this page

Verify at the official NPI Registry.