NPIMap

Organization Active NPI

Calumet County

  • Community Based Hospice Care Agency
  • Chilton, WI
National Provider Identifier
1235120791
Registry record updated Nov 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
557 Issued in WI
Legal business name
CALUMET COUNTY
Practice address
206 Court St
Chilton, WI 53014-1127
Phone
(920) 849-1493
Fax
(920) 849-1476
NPI assigned
Nov 3, 2005
Last updated
Nov 10, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2023

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

Authorized official

Name
Todd Romenesko
Title
County Administrator
Phone
(920) 849-1448

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 557 WI Primary

Addresses

Primary practice location

206 Court St
Chilton, WI 53014-1127

Mailing address

206 Court St
Chilton, WI 53014-1127
Phone (920) 849-1423

Other identifiers 1

IdentifierTypeStateIssuer
43188600MedicaidWI

Other names 1

  • Calumet County Hospice Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111115000736 WI Part A Provider - Hospice 1254347586 Practice locations: Chilton, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1235120791. Details of each certification follow.

Hospice certification: CCN 521563

Legal name
CALUMET COUNTY
Doing business as
HOME HEALTHCARE/HOSPICE AGENCY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 9, 1998
Last certification
May 25, 2022
Ownership / control type
Government - County
Organization structure
GovernmentNon-profit
Incorporated
May 29, 1848 in WI
Enrollment address
206 Court St
Chilton, WI 53014-1198

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Calumet County Hospice AgencyCCN 521563 · All quality measures
Ownership
Government
Certified
Nov 9, 1998
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Calumet Co-Human Serv11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Benjamin Matthew Dellaria Individual Contracted Managing EmployeeMedical Director Jan 1, 2021
Calumet County Organization, Chilton, WI Operational/Managerial Control Nov 9, 1998 100%
Rebecca Tiffany Individual Operational/Managerial ControlClinical Supervisor Oct 21, 2023
Lynn Brenner Individual Operational/Managerial ControlDeputy Director Jun 8, 2015
Nicole Ruh Individual Operational/Managerial ControlClinical Supervisor Oct 21, 2023
Todd Romenesko Individual W-2 Managing EmployeeCeo/County Administrator Apr 1, 2014

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Calumet County HHC/Hospice AgencyChilton, WI, CCN 527085 Home health agency Operational/Managerial Control Jul 20, 1976

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699574400000",
    "number": "1235120791",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 COURT ST",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141127",
            "telephone_number": "920-849-1423",
            "fax_number": "920-849-1476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 COURT ST",
            "city": "CHILTON",
            "state": "WI",
            "postal_code": "530141127",
            "telephone_number": "920-849-1493",
            "fax_number": "920-849-1476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CALUMET COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2023-11-10",
        "certification_date": "2023-11-10",
        "status": "A",
        "authorized_official_last_name": "ROMENESKO",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "COUNTY ADMINISTRATOR",
        "authorized_official_telephone_number": "920-849-1448"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WI",
            "license": "557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43188600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Calumet County Hospice",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Chilton, WI

Sources for this page

Verify at the official NPI Registry.