NPIMap

Organization Active NPI

Beaver Dam Community Hospitals Inc

  • Surgery Physician
  • Beaver Dam, WI
National Provider Identifier
1366833394
Registry record updated Mar 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
851-800 Issued in WI
Legal business name
BEAVER DAM COMMUNITY HOSPITALS INC
Practice address
705 S University Ave Ste 350
Beaver Dam, WI 53916
Phone
(920) 887-0379
NPI assigned
Feb 12, 2015
Organization subpart
Yes
Parent organization
MARSHFIELD CLINIC HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 3, 2022

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

Authorized official

Name
Gordon T Edwards
Title
Cfo/Coo/Ao
Phone
(715) 387-5823

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X 851-800 WI Primary

Addresses

Primary practice location

705 S University Ave Ste 350
Beaver Dam, WI 53916

Mailing address

1000 N Oak Ave
Attn: Provider Enrollment Services/WWP
Marshfield, WI 54449-5703
Phone (715) 389-0660

Other names 1

  • (Inactive) Marshfield Medical Center - Beaver Dam Surgical Specialists Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040210000666 WI Part B Supplier - Clinic/Group Practice 2567370539 Receives reassigned benefits from 1,519 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wauwatosa, WI; Waupun, WI; Watertown, WI; Horicon, WI; Columbus, WI; Beaver Dam, WI

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Part of
Marshfield Clinic Health System Inc

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1423699200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1366833394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 N OAK AVE",
            "address_2": "ATTN: PROVIDER ENROLLMENT SERVICES/WWP",
            "city": "MARSHFIELD",
            "state": "WI",
            "postal_code": "544495703",
            "telephone_number": "715-389-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "705 S UNIVERSITY AVE STE 350",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-887-0379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER DAM COMMUNITY HOSPITALS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARSHFIELD CLINIC HEALTH SYSTEM INC",
        "enumeration_date": "2015-02-12",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-03",
        "status": "A",
        "authorized_official_last_name": "EDWARDS",
        "authorized_official_first_name": "GORDON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO/COO/AO",
        "authorized_official_telephone_number": "715-387-5823"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "WI",
            "license": "851-800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "(Inactive) Marshfield Medical Center - Beaver Dam Surgical Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; 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.