NPIMap

Organization Active NPI

Primary Connection Health Care, Inc

Doing business as Bridge Community Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Merrill, WI
National Provider Identifier
1265723688
Registry record updated Apr 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PRIMARY CONNECTION HEALTH CARE, INC
Doing business as
Bridge Community Health Clinic
Practice address
401 W. Main Street
Merrill, WI 54452
Phone
(715) 539-8181
Fax
(715) 539-8109
NPI assigned
Apr 20, 2011
Last updated
Apr 20, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
PRIMARY CONNECTION HEALTH CARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2011

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

Authorized official

Name
Laura E Scudiere, MPH
Title
Executive Director
Phone
(715) 848-4884

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

401 W. Main Street
Merrill, WI 54452

Mailing address

1810 N 2ND Street
Wausau, WI 54403
Phone (715) 848-4884

Other identifiers 1

IdentifierTypeStateIssuer
32956400MedicaidWI

Other names 1

  • Bridge Community Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265723688. Details of each certification follow.

  • CCN 521840 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 521840

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BRIDGES COMMUNITY HEALTH CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 16, 2011
Last certification
Dec 16, 2011
Ownership / control type
For profit – partnership
Facility address
401 W Main Street
Merrill, WI 54452
Related CCNs
521809

National Provider Directory

National Provider Directory
Tax ID family
Bridge Community Health2 organizations share this tax ID, including this one
Part of
Bridge Community Health

Other organizations with this tax ID 1

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

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1303257600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303257600000",
    "number": "1265723688",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1810 N 2ND STREET",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "54403",
            "telephone_number": "715-848-4884",
            "fax_number": "715-845-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W. MAIN STREET",
            "city": "MERRILL",
            "state": "WI",
            "postal_code": "54452",
            "telephone_number": "715-539-8181",
            "fax_number": "715-539-8109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CONNECTION HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRIMARY CONNECTION HEALTH CARE, INC",
        "enumeration_date": "2011-04-20",
        "last_updated": "2011-04-20",
        "status": "A",
        "authorized_official_last_name": "SCUDIERE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "715-848-4884",
        "authorized_official_credential": "MPH"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32956400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bridge Community Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Merrill, WI

Sources for this page

Verify at the official NPI Registry.