NPIMap

Organization Active NPI

Polk County-Dept of Administration

Doing business as Polk County Health Dept/Healthcheck

  • Public Health or Welfare Agency
  • Balsam Lake, WI
National Provider Identifier
1295964435
Registry record updated Aug 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Public Health or Welfare AgencyTaxonomy code 251K00000X
Legal business name
POLK COUNTY-DEPT OF ADMINISTRATION
Doing business as
Polk County Health Dept/Healthcheck
Practice address
100 Polk County PLZ
Ste 1801
Balsam Lake, WI 54810-9071
Phone
(715) 485-8500
Fax
(715) 485-8500
NPI assigned
Jul 9, 2009
Last updated
Aug 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 14, 2013

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

Authorized official

Name
Mrs. Gretchen Sampson
Title
Director
Phone
(715) 485-8500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X Primary

Addresses

Primary practice location

100 Polk County PLZ
Ste 1801
Balsam Lake, WI 54810-9071

Mailing address

100 Polk County PLZ
Ste 180
Balsam Lake, WI 54810-9071
Phone (715) 485-8500

Other names 1

  • POLK COUNTY HEALTH DEPT/HEALTHCHECK Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20131021000226 WI Part B Supplier - Mass Immunization (Roster Biller Only) 4587560586 Practice locations: Balsam Lake, WI

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
Polk Co PH HL SRV7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

220 Scholl Ct
Amery, WI 54001
Phone (715) 268-7107

100 Polk County Plz
Ste 1801
Balsam Lake, WI 54810
Phone (715) 485-8500

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Polk County-Dept of AdministrationAmery, WI, CCN 525507 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 1966
Jan 1, 1966

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1247097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1376438400000",
    "number": "1295964435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 POLK COUNTY PLZ",
            "address_2": "STE 180",
            "city": "BALSAM LAKE",
            "state": "WI",
            "postal_code": "548109071",
            "telephone_number": "715-485-8500",
            "fax_number": "715-485-8500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 POLK COUNTY PLZ",
            "address_2": "STE 1801",
            "city": "BALSAM LAKE",
            "state": "WI",
            "postal_code": "548109071",
            "telephone_number": "715-485-8500",
            "fax_number": "715-485-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POLK COUNTY-DEPT OF ADMINISTRATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-09",
        "last_updated": "2013-08-14",
        "status": "A",
        "authorized_official_last_name": "SAMPSON",
        "authorized_official_first_name": "GRETCHEN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-485-8500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "POLK COUNTY HEALTH DEPT/HEALTHCHECK",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Balsam Lake, WI

Sources for this page

Verify at the official NPI Registry.