NPIMap

Organization Active NPI

Thedacare, Incorporated

  • Durable Medical Equipment & Medical Supplies
  • Shawano, WI
National Provider Identifier
1376554865
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
THEDACARE, INCORPORATED
Practice address
100 County Road B
Shawano, WI 54166
Phone
(920) 969-0919
Fax
(920) 730-3433
NPI assigned
Aug 10, 2006
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 004-0000148276-01 WI
Durable Medical Equipment & Medical Supplies 332B00000X WI Primary

Addresses

Primary practice location

100 County Road B
Shawano, WI 54166

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 969-0919

Other identifiers 1

IdentifierTypeStateIssuer
41700000MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930028164 WI DME Supplier - Medical Supply CompanyDME Supplier - Medical Supply Company With Respiratory TherapistDME Supplier - Oxygen & Equipment 1759294887 Practice locations: Shawano, WI

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Thedacare Phys Iola Fam20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All facility ownership & control disclosures 15

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

FacilityTypeRoleSince
Thedacare Medical Center - Berlin, Inc.Berlin, WI, CCN 521355 Hospital Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 521303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 52Z303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 521346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 52Z346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Regional Medical Center-Neenah IncNeenah, WI, CCN 520045 Hospital Operational/Managerial Control Jan 19, 2011
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 520160 Hospital Operational/Managerial Control Nov 22, 2010
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 521334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 52Z334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - New London, IncNew London, WI, CCN 521326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Medical Center - New London, IncNew London, WI, CCN 52Z326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 52T160 Hospital Operational/Managerial Control Jan 1, 2024
Juliette ManorBerlin, WI, CCN 525286 Skilled nursing facility Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 528614 Rural health clinic Operational/Managerial Control Jan 19, 2011
Shawano Medical Center IncClintonville, WI, CCN 528608 Rural health clinic Operational/Managerial Control Jan 19, 2011

Owned or controlled facilities with NPI records 30

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

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1376554865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-969-0919",
            "fax_number": "920-730-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 COUNTY ROAD B",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "54166",
            "telephone_number": "920-969-0919",
            "fax_number": "920-730-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "004-0000148276-01",
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41700000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawano, WI

Sources for this page

Verify at the official NPI Registry.