Agnesian Healthcare Inc

Primary specialty

Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X

Legal business name

AGNESIAN HEALTHCARE INC

Doing business as

Mercury Family Medical Center

Practice address

912 S Hickory St
Fond Du Lac, WI 54935-5530

Phone

(920) 929-7490

NPI assigned

Feb 21, 2007

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Stephanie K Krupp

Title

Business Director

Phone

(920) 907-3907

Specialties & licenses 1

Addresses

Other names 1

• MERCURY FAMILY MEDICAL CENTER Doing business as

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

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

• Agnesian Healthcare

  dba Psychiatric Associates

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Beaver Dam, WI
  • NPI 1700817657

  O20031104000263

  Same enrollment
• Agnesian Healthcare Inc

  dba Agnesian Chiropractic Care

  • Chiropractor
  • Fond Du Lac, WI
  • NPI 1437405925

  O20031104000263

  Same enrollment
• Agnesian Healthcare Inc

  dba SSM Health Fond Du Lac Regional Clinic

  • Family Medicine Physician
  • Fond Du Lac, WI
  • NPI 1730162991

  O20031104000263

  Same enrollment
• Agnesian Healthcare Inc

  dba SSM Health Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Fond Du Lac, WI
  • NPI 1841320884

  O20031104000263

  Same enrollment
• Agnesian Healthcare, Inc

  dba SSM Health St Agnes Hospital Fond Du Lac

  • General Acute Care Hospital
  • Fond Du Lac, WI
  • NPI 1346228541

  O20031104000263

  Same enrollment

Locations

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

{
    "created_epoch": "1172016000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1356476543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "912 S HICKORY ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355530",
            "telephone_number": "920-929-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 S HICKORY ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355530",
            "telephone_number": "920-929-7490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-21",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "KRUPP",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS DIRECTOR",
        "authorized_official_telephone_number": "920-907-3907"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCURY FAMILY MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Agnesian Healthcare Inc (SSM Health Pharmacy)
• Agnesian Healthcare Inc (Fond du Lac Regional Optical)
• Agnesian Healthcare Inc (Fond Du Lac Regional Clinc)
• Agnesian Healthcare Inc (Fond Du Lac Regional Clinic)
• Agnesian Healthcare Inc (SSM Health Pharmacy)
• Agnesian Healthcare Inc (SSM Health Fond Du Lac Regional Clinic)
• Agnesian Healthcare Inc (Agnesian Chiropractic Care)
• Agnesian Healthcare Inc (Fond Du Lac Regional Clinic)
• Agnesian Healthcare Inc (SSM Health Fond Du Lac Regional Clinic)
• Agnesian Healthcare Inc (SSM Health Fond Du Lac Regional Clinic)

• Multi-Specialty Clinic/Center in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Multi-Specialty Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.