NPIMap

Organization Active NPI

Black River Memorial Hospital Inc

  • Home Health Agency
  • Black River Falls, WI
National Provider Identifier
1215085253
Registry record updated Dec 16, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
527298 Issued in WI
Legal business name
BLACK RIVER MEMORIAL HOSPITAL INC
Practice address
311 County Road a Ste 1
Black River Falls, WI 54615-8205
Phone
(715) 284-5361
Fax
(715) 284-1398
NPI assigned
Jan 8, 2007
Last updated
Dec 16, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2016

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

Authorized official

Name
Mary Beth White-Jacobs, RN BSN MHA FACHE
Title
President & Ceo
Phone
(715) 284-5361

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 527298 WI Primary

Addresses

Primary practice location

311 County Road a Ste 1
Black River Falls, WI 54615-8205

Mailing address

711 W Adams St
Black River Falls, WI 54615-9108
Phone (715) 284-5361

Other identifiers 1

IdentifierTypeStateIssuer
41538200MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040128000517 WI Part B Supplier - Clinic/Group Practice 3173431178 Receives reassigned benefits from 221 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Black River Falls, WI; Whitehall, WI

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

311 County Road A
Ste 1
Black River Falls, WI 54615
Phone (715) 284-5361

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-3604

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1481846400000",
    "number": "1215085253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 COUNTY ROAD A STE 1",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546158205",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2016-12-16",
        "status": "A",
        "authorized_official_last_name": "WHITE-JACOBS",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "715-284-5361",
        "authorized_official_credential": "RN BSN MHA FACHE"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "527298",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41538200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.