Beaver Dam Community Hospitals Inc
Organization Active NPI Hospitalist Physician · Beaver Dam, WI
NPI 1235541202 · NPPES record last updated Mar 2, 2022
Key facts
- NPI
- 1235541202
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hospitalist Physician 208M00000X
- Legal business name
- BEAVER DAM COMMUNITY HOSPITALS INC
- Practice address
- 707 S University Ave
Beaver Dam, WI 53916 - Phone
- (920) 887-7181
- Fax
- (920) 887-3422
- NPI assigned
- May 27, 2014
- Organization subpart
- Yes
- Parent organization (as reported)
- MARSHFIELD CLINIC HEALTH SYSTEM INC
Authorized official
- Name
- Gordon T Edwards
- Title
- Cfo/Coo/Ao
- Phone
- (715) 387-5823
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 14
Practitioners 4
-
Julie C Dietz, MD
-
Erika H Poehm, MD
-
Robert G Zick, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040210000666 | WI | Part B Supplier - Clinic/Group Practice | 2567370539 |
Receives reassigned benefits from 1,519 practitioners 15 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Wauwatosa, WI; Waupun, WI; Watertown, WI; Horicon, WI; Columbus, WI; Beaver Dam, WI |
National Provider Directory
- Part of
- Marshfield Clinic Health System Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hospitalist Physician |
208M00000X | Yes |
Addresses
Primary practice location
707 S University Ave
Beaver Dam, WI 53916
Mailing address
1000 N Oak Ave
Attn: Provider Enrollment Services/WWP
Marshfield, WI 54449-5703
Phone (715) 389-0660
Other names
- (inactive) Marshfield Medical Center - Beaver Dam Hospitalist Group
Other providers in Beaver Dam, WI
- Timothy J Baumann
- Devyn Beaugh
- Beaver Dam Al Operations LLC
- Beaver Dam Assisted Living, LLC
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
- Beaver Dam Community Hospitals Inc
All providers in Beaver Dam, WI · Hospitalist Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 2, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.