NPIMap

Organization Active NPI

Aspirus Medford Hospital & Clinics, Inc.

Doing business as Aspirus Rib Lake Clinic

  • Rural Health Clinic/Center
  • Rib Lake, WI
National Provider Identifier
1265502173
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.
Doing business as
Aspirus Rib Lake Clinic
Practice address
1121 Highway 102
Rib Lake, WI 54470
Phone
(715) 427-5701
Fax
(715) 427-3863
NPI assigned
Nov 8, 2006
Last updated
Jun 10, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Authorized official

Name
Jerry M Yang
Title
SVP & Chief Financial Officer
Phone
(715) 847-2526

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

1121 Highway 102
Rib Lake, WI 54470

Mailing address

135 S Gibson St
Medford, WI 54451-1622
Phone (715) 748-8100

Other identifiers 1

IdentifierTypeStateIssuer
21303300MedicaidWI

Other names 1

  • ASPIRUS RIB LAKE CLINIC Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040129000007 WI Part B Supplier - Clinic/Group Practice 5799688602 Receives reassigned benefits from 383 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Medford, WI; Rib Lake, WI; Prentice, WI; Phillips, WI; Athens, WI; Gilman, WI
O20071211000401 WI Part A Provider - Critical Access Hospital 5799688602 Receives reassigned benefits from 334 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Prentice, WI; Gilman, WI; Athens, WI; Medford, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265502173. Details of each certification follow.

Hospital certification: CCN 521324

Legal name
ASPIRUS MEDFORD HOSPITAL & CLINICS INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jun 10, 2002
Last certification
Jul 15, 2015
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Jun 2, 1958 in WI
Enrollment address
135 S Gibson St
Medford, WI 54451-1622

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Aspirus Medford Hospital & Clinics, IncCCN 521324 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1121 State Highway 102
Rib Lake, WI 54470
Phone (715) 427-5701

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Jeffrey Koenig Individual Corporate DirectorBoard Member Nov 1, 2023
Michael Holzhueter Individual Corporate DirectorBoard Member Oct 1, 2019
Jerry M Yang Individual Corporate DirectorSVP and Chief Financial Officer Feb 26, 2024
W-2 Managing EmployeeSVP and Chief Financial Offic Feb 26, 2024
Operational/Managerial ControlSVP and Chief Financial Officer Feb 26, 2024
Randy Juedes Individual Corporate DirectorBoard Member Oct 1, 2019
John Lange Individual Corporate DirectorBoard Member Oct 1, 2020
Susan M Schneider Individual Corporate DirectorBoard Member Oct 1, 2020
Aspirus, Inc Organization, Wausau, WI Non-profit 5% Or Greater Indirect Ownership Interest Mar 1, 2001 100%
Dale Hustedt Individual Corporate OfficerBoard Member Jul 2, 2018
W-2 Managing EmployeeCeo Jul 2, 2018
Rachel a Dixon Individual Corporate DirectorBoard Member Jan 17, 2018
Leonard W Hamman Individual Corporate DirectorBoard Member/Secretary Jul 26, 2016
Greg Shaw Individual Corporate Director Apr 13, 2015
W-2 Managing EmployeeVP of Finance Apr 13, 2015
Lori Peck Individual Corporate DirectorVP-Finance Sep 30, 2015
W-2 Managing EmployeeVP-Finance Sep 30, 2015
Operational/Managerial ControlVP-Finance Sep 30, 2015
Tyler Hack Individual Corporate DirectorVP - Revenue Cycle Feb 26, 2024
W-2 Managing EmployeeVP - Revenue Cycle Feb 26, 2024
Operational/Managerial ControlVP - Revenue Cycle Feb 26, 2024
Diane M Anderson Individual Corporate DirectorBoard Member Oct 1, 2022
Matthew F Heywood Individual Corporate DirectorPresident - Chief Executive Officer Jul 31, 2013
W-2 Managing EmployeePresident - Chief Executive O Jul 31, 2013
Operational/Managerial ControlPresident - Chief Executive Officer Jul 31, 2013

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 18

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 18

Affiliated clinicians 193

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 193

NPI Registry JSON

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

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717977600000",
    "number": "1265502173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 S GIBSON ST",
            "city": "MEDFORD",
            "state": "WI",
            "postal_code": "544511622",
            "telephone_number": "715-748-8100",
            "fax_number": "715-748-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1121 HIGHWAY 102",
            "city": "RIB LAKE",
            "state": "WI",
            "postal_code": "54470",
            "telephone_number": "715-427-5701",
            "fax_number": "715-427-3863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASPIRUS MEDFORD HOSPITAL & CLINICS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-08",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SVP & CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "715-847-2526"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21303300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASPIRUS RIB LAKE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ASPIRUS RIB LAKE CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rib Lake, WI

Sources for this page

Verify at the official NPI Registry.