NPIMap

Organization Active NPI

St Nicholas Hospital-Sisters of the Third Order of St Francis

Doing business as St Nicholas Hospital Professional Services Group

  • Nurse Practitioner
  • Sheboygan, WI
National Provider Identifier
1275943243
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS
Doing business as
St Nicholas Hospital Professional Services Group
Practice address
3100 Superior Ave
Sheboygan, WI 53081-1948
Phone
(920) 459-8300
NPI assigned
Apr 30, 2014
Last updated
Dec 22, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCISAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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

Authorized official

Name
Andrew Bagnall
Title
Ceo
Phone
(920) 459-4705

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

3100 Superior Ave
Sheboygan, WI 53081-1948

Mailing address

3100 Superior Ave
Sheboygan, WI 53081-1948
Phone (920) 459-8300

Other names 1

  • St Nicholas Hospital Professional Services Group Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address stvincent_stmary_stnicholas_stclare@ewd.direct.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202001172 WI Part B Supplier - Clinic/Group Practice 8325931652 Receives reassigned benefits from 706 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kohler, WI; Sheboygan, WI; Oostburg, WI; Plymouth, WI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Stnicholas Physician SVC GP

Practitioners & affiliated clinicians

Practitioners 205

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 205

NPI Registry JSON

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

{
    "created_epoch": "1398816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640131200000",
    "number": "1275943243",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811948",
            "telephone_number": "920-459-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 SUPERIOR AVE",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530811948",
            "telephone_number": "920-459-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST NICHOLAS HOSPITAL-SISTERS OF THE THIRD ORDER OF ST FRANCIS",
        "enumeration_date": "2014-04-30",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A",
        "authorized_official_last_name": "BAGNALL",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-459-4705"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "stvincent_stmary_stnicholas_stclare@ewd.direct.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "3100 Superior Ave",
            "city": "Sheboygan",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530811948",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St Nicholas Hospital Professional Services Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Nicholas Hospital Professional Services Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sheboygan, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; 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.