NPIMap

Thedacare, Incorporated

Organization Active NPI Family Medicine Physician · New London, WI

NPI 1376656959 · NPPES record last updated Jan 2, 2024

Key facts

NPI
1376656959
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
THEDACARE, INCORPORATED
Practice address
1405 Mill St
New London, WI 54961-2155
Phone
(920) 830-5900
Fax
(920) 830-5910
NPI assigned
Aug 16, 2006
Organization subpart
No

Authorized official

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

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

Other NPIs on the same Medicare enrollment 1

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

  • Thedacare, Incorporated Counselor · Menasha, WI · NPI 1306959515
    Same enrollment O20031106000088 · O20171115001174 · O20190826001611 · O20230412001822 · O20231220000457 · O20240510003231

Other NPIs with the same Medicare PAC ID 11

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

Practitioners 1,119

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

View all 1,119

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0885560Thedacare Physicians-New London
1405 Mill St, New London, WI 54961		Certificate of waiverJan 31, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (34 enrollments) in WI, UT, WA, CA, KS, NY, PA, NC, MO, FL, IL, NJ, GA, WV, CO, NE, KY, AZ, TX, MA, VA, NM, ME, OR, OH, OK, LA, SC, NV, DC, IA, TN, AL, SD

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 Inc
Neenah, WI · CCN 520045		 Hospital Operational/Managerial Control Jan 19, 2011
Thedacare Regional Medical Center - Appleton, Inc
Appleton, WI · CCN 520160		 Hospital Operational/Managerial Control Nov 22, 2010
Thedacare Medical Center - Waupaca, Inc
Waupaca, WI · CCN 521334		 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - Waupaca, Inc
Waupaca, WI · CCN 52Z334		 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - New London, Inc
New London, WI · CCN 521326		 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Medical Center - New London, Inc
New London, WI · CCN 52Z326		 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Regional Medical Center - Appleton, Inc
Appleton, WI · CCN 52T160		 Hospital Operational/Managerial Control Jan 1, 2024
Juliette Manor
Berlin, 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 Inc
Clintonville, WI · CCN 528608		 Rural health clinic Operational/Managerial Control Jan 19, 2011

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031106000088 WI Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1,069 practitioners
5 other NPIs on this enrollment
O20171115001174 UT Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Draper, UT; Provo, UT
O20190826001611 WA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Washougal, WA; Camas, WA
O20230316001395 CA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 11 practitioners
Practice locations: Westminster, CA; Temecula, CA; Sherman Oaks, CA; San Diego, CA; Rocklin, CA; Moraga, CA; Redlands, CA; Colton, CA…
O20230316002478 KS Part B Supplier - Clinic/Group Practice 1759294887 Practice locations: Wichita, KS
O20230317001807 NY Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 4 practitioners
Practice locations: New York, NY; Southampton, NY; Suffern, NY; Woodbury, NY
O20230323000509 PA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Philadelphia, PA; Old Forge, PA
O20230329002904 NC Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 11 practitioners
Practice locations: Cary, NC; Winston Salem, NC; Raleigh, NC; Mint Hill, NC; Harrisburg, NC; Greenville, NC; Greensboro, NC; Gastonia, NC…
O20230412001445 MO Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
Practice locations: Chesterfield, MO; Saint Louis, MO; Creve Coeur, MO
O20230412001822 FL Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 10 practitioners
1 other NPI on this enrollment
Practice locations: Dade City, FL; Weston, FL; Port St Lucie, FL; Panama City Beach, FL; Orlando, FL; North Miami, FL; Miami, FL; Hobe Sound, FL…
O20230710000068 IL Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
Practice locations: Burr Ridge, IL; Naperville, IL; Oak Park, IL
O20231013001144 NJ Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
Practice locations: Swedesboro, NJ; Verona, NJ
O20231220000457 GA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Atlanta, GA; Savannah, GA; Alpharetta, GA
O20231227003303 WV Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Charleston, WV
O20240207001668 CO Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Erie, CO; Steamboat Springs, CO
O20240507001644 NE Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Fremont, NE
O20240510003231 KY Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
Practice locations: Harrodsburg, KY; Lexington, KY; Prospect, KY
O20240530002129 AZ Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Chandler, AZ; Scottsdale, AZ
O20240806001272 TX Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 7 practitioners
Practice locations: League City, TX; Kingwood, TX; Houston, TX; Grangerland, TX; Frisco, TX; Cypress, TX
O20241118002081 MA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
Practice locations: West Roxbury, MA
O20241204002995 VA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
Practice locations: Henrico, VA; Virginia Beach, VA; Wirtz, VA
O20250203003112 NM Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Albuquerque, NM
O20250207001924 ME Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Augusta, ME
O20250210001337 OR Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Lake Oswego, OR
O20250219003610 OH Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
Practice locations: Columbus, OH; Findlay, OH
O20250306003227 OK Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 4 practitioners
Practice locations: Edmond, OK; Jenks, OK; Vian, OK
O20250306003424 LA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 2 practitioners
Practice locations: Lafayette, LA; Mandeville, LA
O20250312002118 SC Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Columbia, SC
O20250318003209 NV Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Henderson, NV
O20250513002050 DC Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 3 practitioners
Practice locations: Ashton, MD; MC Lean, VA; Silver Spring, MD
O20250822001291 IA Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: North Liberty, IA
O20251104000251 TN Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Knoxville, TN
O20260327002719 AL Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Summerdale, AL
O20260512001265 SD Part B Supplier - Clinic/Group Practice 1759294887 Receives reassigned benefits from 1 practitioner
Practice locations: Sioux Falls, SD

National Provider Directory

Locations (25 of 41)

12101 SE Colby Ave
Hobe Sound, FL 33455

13230 Ballantyne Corporate Pl
Charlotte, NC 28277

122 E College Ave
Appleton, WI 54911
Phone (920) 996-3264

2500 E Capitol Dr
Fl 2
Appleton, WI 54911

1818 N Meade St
Ste 140W
Appleton, WI 54911
Phone (920) 738-5730

1818 N Meade St
Rm N255
Appleton, WI 54911
Phone (920) 730-3383

1818 N Meade St
Ste 140
Appleton, WI 54911

1818 N Meade St
#W120
Appleton, WI 54911
Phone (920) 735-7300

2500 E Capitol Dr
Ste 3350
Appleton, WI 54911

2500 E Capitol Dr
Ste 1300
Appleton, WI 54911
Phone (920) 738-4600

2500 E Capitol Dr
Ste 2500
Appleton, WI 54911

3000 E College Ave
Appleton, WI 54915
Phone (920) 702-6410

4480 W Spencer St
Appleton, WI 54914
Phone (920) 738-4800

3916 N Intertech Ct
Appleton, WI 54913
Phone (920) 996-1000

820 W Association Dr
Appleton, WI 54914
Phone (920) 380-4951

2500 E Capitol Dr
Ste 1100
Appleton, WI 54911
Phone (920) 358-1573

2500 E Capitol Dr
Ste 1800
Appleton, WI 54911
Phone (920) 358-1566

1818 N Meade St
Rm 3515
Appleton, WI 54911
Phone (920) 831-1829

1010 S Oneida St
Appleton, WI 54915
Phone (920) 733-7726

620 E Longview Dr
Appleton, WI 54911
Phone (920) 238-3340

225 Memorial Dr
Ste 2030
Berlin, WI 54923
Phone (920) 361-5737

225 Memorial Dr
Ste 1100
Berlin, WI 54923
Phone (920) 232-1130

191 Memorial Dr
Ste 200
Berlin, WI 54923
Phone (920) 361-6330

225 Memorial Dr
#1600
Berlin, WI 54923
Phone (920) 361-6360

300 S Main St
Clintonville, WI 54929

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

1405 Mill St
New London, WI 54961-2155

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 454-4229

Other identifiers

IdentifierTypeStateIssuer
32883500MedicaidWI
WI2721OtherWIMEDICARE PTAN

Other names

  • ThedaCare Physicians Doing business as

Other providers in New London, WI

All providers in New London, WI · Family Medicine Physician in Wisconsin

Sources for this page

Verify at the official NPI Registry.