NPIMap

Organization Active NPI

Community Memorial Hospital, Incorporated

Doing business as d/b/a Breast Surgery Experts of Northeast Wisconsin

  • Surgery Physician
  • Oconto Falls, WI
National Provider Identifier
1386925915
Registry record updated Sep 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
395597-20 Issued in WI
Legal business name
COMMUNITY MEMORIAL HOSPITAL, INCORPORATED
Doing business as
d/b/a Breast Surgery Experts of Northeast Wisconsin
Practice address
835 S Main St
Oconto Falls, WI 54154-1282
Phone
(920) 360-3787
Fax
(888) 848-0225
NPI assigned
Sep 9, 2011
Last updated
Sep 9, 2011By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMUNITY MEMORIAL HOSPITAL, INCORPORATEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 9, 2011

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

Authorized official

Name
Daniel Degroot
Title
Ceo
Phone
(920) 846-3444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 395597-20 WI Primary

Addresses

Primary practice location

835 S Main St
Oconto Falls, WI 54154-1282

Mailing address

25630 Network PL
Chicago, IL 60673-1256
Phone (920) 360-3787

Other identifiers 2

IdentifierTypeStateIssuer
1750302089OtherWIPROVIDER
1851477913OtherWICMH NPI

Other names 1

  • d/b/a Breast Surgery Experts of Northeast Wisconsin Doing business as

National Provider Directory

National Provider Directory
Tax ID family
St Clare Memorial Hospital16 organizations share this tax ID, including this one
Part of
St Clare Memorial Hospital

Other organizations with this tax ID 15

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

View all 15

Locations

25630 Network Pl
Chicago, IL 60673

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1315526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315526400000",
    "number": "1386925915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25630 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731256",
            "telephone_number": "920-360-3787",
            "fax_number": "888-848-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541282",
            "telephone_number": "920-360-3787",
            "fax_number": "888-848-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MEMORIAL HOSPITAL, INCORPORATED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMUNITY MEMORIAL HOSPITAL, INCORPORATED",
        "enumeration_date": "2011-09-09",
        "last_updated": "2011-09-09",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-846-3444"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "395597-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER",
            "identifier": "1750302089",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMH NPI",
            "identifier": "1851477913",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "d/b/a Breast Surgery Experts of Northeast Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oconto Falls, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.