NPIMap

Organization Active NPI

St. Camillus Health Center, Inc.

  • Community Based Hospice Care Agency
  • Wauwatosa, WI
National Provider Identifier
1366690679
Registry record updated Dec 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
2026 Issued in WI
Legal business name
ST. CAMILLUS HEALTH CENTER, INC.
Practice address
10101 W Wisconsin Ave
Wauwatosa, WI 53226-4861
Phone
(414) 258-2418
Fax
(414) 259-4534
NPI assigned
Aug 29, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2023

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

Authorized official

Name
Ann Ondrejicka, BSW
Title
Administrator
Phone
(414) 258-2418

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 2026 WI Primary

Addresses

Primary practice location

10101 W Wisconsin Ave
Wauwatosa, WI 53226-4861

Mailing address

10101 W Wisconsin Ave
Wauwatosa, WI 53226-4861
Phone (414) 258-2418

Other practice location 1

10101 W Wisconsin Ave
Wauwatosa, WI 53226-4861
Phone (414) 258-2418

Other identifiers 1

IdentifierTypeStateIssuer
521588OtherWIMEDICARE PROVIDER NUMBER

Other names 2

  • St. Camillus Home Health Doing business as
  • St. Camillus Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090903000304 WI Part A Provider - Hospice 6305839952 Practice locations: Wauwatosa, WI

Hospice certification: CCN 521588

Legal name
ST. CAMILLUS HEALTH CENTER, INC.
Doing business as
ST CAMILLUS HOSPICE AGENCY
Certification status
Active
Provider type (POS)
Hospice
Participating since
Apr 21, 2010
Last certification
Apr 21, 2010
Ownership / control type
Non-Profit - Church
Organization structure
CorporationNon-profit
Incorporated
May 5, 2010 in WI
Enrollment address
10101 W Wisconsin Ave
Wauwatosa, WI 53226

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
St Camillus HospiceCCN 521588
Ownership
Non-Profit
Certified
Apr 21, 2010
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Camillus Cares Home Health Agency3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Pedro Tramontin Individual Corporate Officer Jan 1, 2014
Mario Crivello Individual Corporate DirectorMedical Director Sep 8, 2009
Leandro Blanco Individual Corporate Officer Jan 1, 2014
Kevin Schwab Individual Corporate Director Aug 21, 2009
W-2 Managing Employee Aug 21, 2009
Justin J Munzel Individual Corporate OfficerChief Financial Officer Mar 1, 2016
Agustin Orosa Individual Corporate Officer Jan 1, 2017
Shannon Angell Individual Corporate OfficerOfficer Sep 1, 2021
Nick Laubusch Individual Corporate Director Oct 23, 2009

Practitioners & affiliated clinicians

Affiliated clinicians 4

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701734400000",
    "number": "1366690679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10101 W WISCONSIN AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264861",
            "telephone_number": "414-258-2418",
            "fax_number": "414-259-4534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10101 W WISCONSIN AVE",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532264861",
            "telephone_number": "414-258-2418",
            "fax_number": "414-259-4534"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10101 W Wisconsin Ave",
            "address_purpose": "LOCATION",
            "city": "Wauwatosa",
            "state": "WI",
            "postal_code": "532264861",
            "country_code": "US",
            "telephone_number": "414-258-2418",
            "fax_number": "414-259-4534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. CAMILLUS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-29",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A",
        "authorized_official_last_name": "ONDREJICKA",
        "authorized_official_first_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "414-258-2418",
        "authorized_official_credential": "BSW"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WI",
            "license": "2026",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER NUMBER",
            "identifier": "521588",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Camillus Home Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Camillus Hospice",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. Camillus Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.