NPIMap

Organization Active NPI

St. Camillus Health Center, Inc.

Doing business as Camillus Cares Home Health Agency

  • Home Health Agency
  • Wauwatosa, WI
National Provider Identifier
1407922776
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
148 Issued in WI
Legal business name
ST. CAMILLUS HEALTH CENTER, INC.
Doing business as
Camillus Cares Home Health Agency
Practice address
10101 W Wisconsin Ave
Wauwatosa, WI 53226-4814
Phone
(414) 258-2418
Fax
(414) 259-4534
NPI assigned
Nov 28, 2006
Last updated
Apr 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Authorized official

Name
Justin Munzel
Title
Chief Financial Officer
Phone
(414) 259-8355

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 148 WI Primary

Addresses

Primary practice location

10101 W Wisconsin Ave
Wauwatosa, WI 53226-4814

Mailing address

10101 W Wisconsin Ave
Wauwatosa, WI 53226-4814
Phone (414) 258-2418

Other identifiers 2

IdentifierTypeStateIssuer
41512800MedicaidWI
1407922776OtherWIUNITEDHEALTHCARE

Other names 1

  • Camillus Cares Home Health Agency Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address directmessage@stcamillushealthcenter.brightree.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040407001437 WI Part A Provider - Home Health Agency 6305839952 Practice locations: Wauwatosa, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407922776. Details of each certification follow.

Home health agency certification: CCN 527164

Legal name
ST. CAMILLUS HEALTH CENTER, INC.
Doing business as
ST. CAMILLUS HOME HEALTH AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Sep 11, 1985
Last certification
Apr 6, 2016
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
May 9, 1997 in WI
Enrollment address
10101 W Wisconsin Ave
Wauwatosa, WI 53226-4861

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: Home health agency

Medicare Care Compare
Listed as
St. Camillus Home Health AgencyCCN 527164 · All quality measures
Overall star rating
2 of 5
Ownership
Non-Profit
Certified
Sep 11, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

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.

Locations

909 N Mayfair Rd
Ste 201
Milwaukee, WI 53226

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Mario Crivello Individual Corporate Officer Jan 1, 1997
Operational/Managerial Control Jan 1, 1997
Stacy Barnes Individual Corporate Officer Oct 1, 2023
Judith Taylor Individual Corporate Officer Oct 1, 2023
Christopher Mark Cherney Individual Corporate DirectorCfo Mar 6, 2023
Ann Ondrejicka Individual W-2 Managing EmployeeAdministrator - Home Health Oct 4, 2023 100%
Brian Savoie Individual Corporate Officer Oct 1, 2023
George Winzenburg Individual Corporate Officer Oct 1, 2023
Daniel J Geenen Individual Corporate Officer May 1, 2024
Shannon Angell Individual Corporate OfficerCeo Aug 1, 2021 100%
Greg Wilgenbusch Individual Corporate Officer Oct 1, 2023
Nick Laubusch Individual Corporate Director Mar 24, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 10

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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1407922776",
    "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": "532264814",
            "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": "532264814",
            "telephone_number": "414-258-2418",
            "fax_number": "414-259-4534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CAMILLUS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "MUNZEL",
        "authorized_official_first_name": "JUSTIN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "414-259-8355"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41512800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITEDHEALTHCARE",
            "identifier": "1407922776",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "directmessage@stcamillushealthcenter.brightree.net",
            "affiliation": "N",
            "address_1": "10101 W Wisconsin Ave",
            "city": "Wauwatosa",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532264814",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Camillus Cares Home Health Agency",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Camillus Cares Home Health Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.