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Organization Active NPI

Group Health Cooperative of South Central Wisconsin

  • Health Maintenance Organization
  • Madison, WI
National Provider Identifier
1245260165
Registry record updated Apr 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
00053899 Issued in WI
Legal business name
GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN
Practice address
1265 John Q Hammons Dr
Madison, WI 53717-1921
Phone
(608) 251-4156
Fax
(608) 662-4984
NPI assigned
Jul 4, 2006
Last updated
Apr 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2024

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

Authorized official

Name
Bruce Quade
Title
Cfo
Phone
(608) 251-4156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 00053899 WI Primary

Addresses

Primary practice location

1265 John Q Hammons Dr
Madison, WI 53717-1921

Mailing address

1265 John Q Hammons Dr
Madison, WI 53717-1921
Phone (608) 251-4156

Other identifiers 1

IdentifierTypeStateIssuer
69000100MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040227000306 WI Part B Supplier - Clinic/Group Practice 3870489586 Receives reassigned benefits from 443 practitioners
Practice locations: Madison, WI; Fitchburg, WI; Deforest, WI

National Provider Directory

National Provider Directory

Locations

210 N Main St
Ste 102
Deforest, WI 53532
Phone (608) 846-2454

815 S Main St
Deforest, WI 53532
Phone (608) 846-4605

1705 Hoffman St
Madison, WI 53704
Phone (608) 441-3220

208 E Olin Ave
Ste 105
Madison, WI 53713
Phone (608) 257-9700

5301 Tokay Blvd
Madison, WI 53711

Practitioners & affiliated clinicians

Practitioners 466

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 466

NPI Registry JSON

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

{
    "created_epoch": "1151971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712793600000",
    "number": "1245260165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1265 JOHN Q HAMMONS DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171921",
            "telephone_number": "608-251-4156",
            "fax_number": "608-662-4984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1265 JOHN Q HAMMONS DR",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171921",
            "telephone_number": "608-251-4156",
            "fax_number": "608-662-4984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GROUP HEALTH COOPERATIVE OF SOUTH CENTRAL WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-04",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A",
        "authorized_official_last_name": "QUADE",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "608-251-4156"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "WI",
            "license": "00053899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "69000100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.