NPIMap

Organization Active NPI

Thedacare Medical Center - Shawano, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Shawano, WI
National Provider Identifier
1265618979
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
1051 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - SHAWANO, INC.
Practice address
100 County Road B
Shawano, WI 54166-7072
Phone
(715) 526-2111
Fax
(715) 526-7308
NPI assigned
Jan 11, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 1051 WI Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166-7072

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other names 1

  • SHAWANO MEDICAL CENTER, INC. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070524000100 WI Part A Provider - Critical Access Hospital 5890605836 1 other NPI on this enrollment
Practice locations: Shawano, WI

Hospital certification: CCN 52Z346

Legal name
THEDACARE MEDICAL CENTER - SHAWANO, INC.
Organization structure
CorporationNon-profit
Incorporated
Oct 17, 1991 in WI
Enrollment address
100 County Road B
Shawano, WI 54166-7072

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

Other NPIs with the same Medicare PAC ID 4

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

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
Tax ID family
Shawano Medical Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Froedtert Thedacare Health, Inc. Organization, Milwaukee, WI Corporation, Non-profit Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing EmployeePayer Contracting Jan 1, 2023
Laurie a Carter Individual Corporate DirectorBoard Member Feb 1, 2022
Thedacare, Incorporated Organization, Neenah, WI Corporation, Non-profit Operational/Managerial Control Jan 30, 2011
Mary W Goggans Individual Corporate DirectorBoard Member Feb 1, 2022
Alan Loux Individual Corporate DirectorBoard Member Jan 1, 2023
William Flett Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Imran a Andrabi Individual Corporate OfficerPresident-Ceo Jun 28, 2017
Chuck Dallas Individual Corporate DirectorBoard Member Oct 1, 2008
David W Koeper Individual Corporate DirectorBoard Member Feb 11, 2021
Susan M Pahl Individual W-2 Managing EmployeeDelegated Official Jan 1, 2022
Steven J Price Individual Corporate DirectorBoard Member Jan 1, 2023
Kathleen Pigeon Individual W-2 Managing EmployeeProvider Enrollment Jun 11, 2020
Michael Morse Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 14

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

View all 14

Facilities with the same owner 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1200009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1265618979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541667072",
            "telephone_number": "715-526-2111",
            "fax_number": "715-526-7308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - SHAWANO, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-11",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WI",
            "license": "1051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHAWANO MEDICAL CENTER, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "SHAWANO MEDICAL CENTER, INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

Verify at the official NPI Registry.