NPIMap

Organization Active NPI

Partnership Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Appleton, WI
National Provider Identifier
1225074008
Registry record updated Feb 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PARTNERSHIP COMMUNITY HEALTH CENTER, INC
Practice address
5337 W Grande Market Dr
Appleton, WI 54913-8442
Phone
(920) 731-7445
NPI assigned
Jun 21, 2006
Last updated
Feb 22, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2024

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

Authorized official

Name
Kristene Stacker, RN
Title
Ceo
Phone
(920) 731-7445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

5337 W Grande Market Dr
Appleton, WI 54913-8442

Mailing address

5337 W Grande Market Dr
Appleton, WI 54913-8442
Phone (920) 731-7445

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050503001232 WI Part A Provider - Federally Qualified Health Center (FQHC) 2062452600 Practice locations: Appleton, WI
O20140213001404 WI Part B Supplier - Clinic/Group Practice 2062452600 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Appleton, WI; Oshkosh, WI; Waupaca, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225074008. Details of each certification follow.

Federally qualified health center certification: CCN 521828

Legal name
PARTNERSHIP COMMUNITY HEALTH CENTER INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Aug 23, 2005
Last certification
Aug 23, 2005
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 2004 in WI
Enrollment address
5471 W Waterford LN
Appleton, WI 54913-8510

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

5337 W Grande Market Dr
Appleton, WI 54913
Phone (920) 750-6644

825 W Fulton St
Ste 10
Waupaca, WI 54981

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Christopher Allen Individual Corporate DirectorBoard Member Nov 28, 2010 100%
Cindy Sahotsky Individual Corporate DirectorBoard Member Apr 28, 2016 100%
Peggy Skruch Individual Corporate DirectorBoard Member Apr 13, 2018 100%
Dawn Johanknecht Individual Corporate DirectorBoard Member May 28, 2013 100%
Patricia Sarvela Individual Corporate OfficerChief Development Officer Feb 11, 2013 100%
Kristene S Stacker Individual Corporate OfficerCeo Apr 8, 2008
W-2 Managing EmployeeCeo Apr 8, 2008 100%
Richard J Davison Individual Corporate DirectorBoard Member Jan 22, 2012 100%
Laura a Verhagen Individual Corporate DirectorBoard Member Sep 6, 2024 100%
Penny Bernard Schaber Individual Corporate DirectorBoard Member Mar 31, 2023 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708560000000",
    "number": "1225074008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5337 W GRANDE MARKET DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138442",
            "telephone_number": "920-731-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5337 W GRANDE MARKET DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138442",
            "telephone_number": "920-731-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARTNERSHIP COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-21",
        "last_updated": "2024-02-22",
        "certification_date": "2024-02-22",
        "status": "A",
        "authorized_official_last_name": "STACKER",
        "authorized_official_first_name": "KRISTENE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-731-7445",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.