Thedacare Medical Center - Berlin, Inc.
Organization Active NPI Critical Access Hospital · Ripon, WI
NPI 1326493602 · NPPES record last updated Jan 3, 2024
Key facts
- NPI
- 1326493602
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- License
- 1060 (WI)
- Legal business name
- THEDACARE MEDICAL CENTER - BERLIN, INC.
- Practice address
- 1080 W Fond Du Lac St
Ripon, WI 54971-9286 - Phone
- (920) 361-1313
- NPI assigned
- Apr 25, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- THEDACARE MEDICAL CENTER - BERLIN, INC.
Authorized official
- Name
- Mr. William Flett
- Title
- Chief Financial Officer
- Phone
- (920) 454-4013
Owners & managing parties with NPI records 16
-
Craig Batley, DO
-
Mark Cockley, MD
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 11
Affiliated clinicians 178
-
Julie Ann Abboud, D.P.M.
-
Erik J Amoroso, M.D.
-
Laura L Baehnman, APNP
-
Jennifer Marie Bahr, M.D.
-
Douglas A Bartelt, APNP
-
Deborah Ann Bartmann, APNP
-
Craig Batley, DO
-
Daisy A Boehm, N.P.
-
Kasey Ann Boerner, APNP
-
Kristen A Brazzale, APNP
-
Patrick James Brennan, M.D.
-
David Budde, DO
-
Hillary Busch, DNP, APNP, FNC-BC
-
Andrew W Calvert, MD
-
Kobi S Caracci, PA-C
-
Oleg Chebotarev, MD
Medicare Care Compare: Hospital
- Listed as
- Thedacare Medical Center - Berlin Inc
- Overall star rating
- ★★★☆☆ 3 of 5
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Hospital certification: CCN 521355
- Legal name
- THEDACARE MEDICAL CENTER - BERLIN, INC.
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Dec 1, 2005
- Last certification
- Feb 4, 2009
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 19, 2010 in WI
- Enrollment address
- 225 Memorial Dr
Berlin, WI 54923-1243
All disclosed owners & managing parties 20
| Name | Role | Since | Share |
|---|---|---|---|
| Froedtert Thedacare Health, Inc. |
Operational/Managerial Control | Jan 1, 2024 | |
| Jennifer R Glasheen |
W-2 Managing Employee |
Jan 1, 2024 | |
| Thedacare, Incorporated |
Operational/Managerial Control | Jun 30, 2014 | 100% |
| Craig M Batley |
Corporate Officer |
Jan 1, 2017 | |
| Mark Cockley |
Corporate Director |
Jan 1, 2024 | |
| Michele Clark |
Corporate Director |
Jan 1, 2024 | |
| Margaret Bostelmann |
Corporate Officer |
Apr 17, 2018 | |
| Tammy a Bending |
Corporate Director |
Jan 23, 2017 | |
| W-2 Managing Employee |
Jan 23, 2017 | ||
| Margaret Posorske |
Corporate Director |
Jan 1, 2024 | |
| John M Blazel |
Corporate Officer |
Apr 17, 2018 | |
| William Flett |
Corporate Officer |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Jenna E Walker |
W-2 Managing Employee |
Nov 15, 2011 | |
| Imran a Andrabi |
Corporate Officer |
Jun 28, 2017 | |
| W-2 Managing Employee | Jun 28, 2017 | ||
| Buffy Lynn Detterman |
Corporate Director |
Jan 1, 2024 | |
| Jared Abbrederis |
Corporate Director |
Jan 1, 2022 | |
| Jayson J Duffy |
Corporate Officer |
Jan 1, 2017 | |
| Kirsten E Grove |
Corporate Director |
Jan 1, 2024 | |
| Susan M Pahl |
W-2 Managing Employee |
Jun 1, 2015 | |
| Steven Taylor Rasmussen |
Corporate Director |
Jan 1, 2024 | |
| Kathleen Pigeon |
W-2 Managing Employee | Jun 11, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050302000751 | WI | Part a Provider - Critical Access Hospital | 0446151666 |
Receives reassigned benefits from 50 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Berlin, WI; Ripon, WI; Wautoma, WI |
National Provider Directory
- Tax ID family
- CHN Lifeskills
- Part of
- CHN Lifeskills
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | 1060 | WI | Yes |
Addresses
Primary practice location
1080 W Fond Du Lac St
Ripon, WI 54971-9286
Mailing address
3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 527206 | Other | WI | MEDICARE PTAN |
Other names
- COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL
Other providers in Ripon, WI
- John R Stanton
- Lori K. Steiner
- Karin Suesser
- Tailored Hearing Solutions
- Jamie L Teuteberg
- Tracy L Thompson
- Kathyrn Thomsen
- William K Tordzro
- Daniel Gordon Trampf
- Vydunas G. Tumas
All providers in Ripon, WI · Critical Access Hospital in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.