NPIMap

Organization Active NPI

Stoughton Hospital Association

  • Psychiatric Hospital Unit
  • Stoughton, WI
National Provider Identifier
1437296456
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
STOUGHTON HOSPITAL ASSOCIATION
Practice address
900 Ridge St
Stoughton, WI 53589-1864
Phone
(608) 873-6611
Fax
(608) 873-2255
NPI assigned
Jan 31, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
STOUGHTON HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Daniel C Degroot
Title
President
Phone
(608) 873-2250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X WI Primary

Addresses

Primary practice location

900 Ridge St
Stoughton, WI 53589-1864

Mailing address

900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-6611

Other identifiers 2

IdentifierTypeStateIssuer
11007200MedicaidWI
11007210MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040402001358 WI Part B Supplier - Clinic/Group Practice 7012825706 Receives reassigned benefits from 109 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stoughton, WI; Oregon, WI; McFarland, WI; Cottage Grove, WI
O20100106000583 WI Part A Provider - Critical Access Hospital 7012825706 Practice locations: Stoughton, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437296456. Details of each certification follow.

Hospital certification: CCN 52M343

Legal name
STOUGHTON HOSPITAL ASSOCIATION
Doing business as
STOUGHTON HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Oct 9, 1924 in WI
Enrollment address
900 Ridge St
Stoughton, WI 53589-1864

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Stoughton Hosp Association

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

110 Limestone Pass
Ste 103
Cottage Grove, WI 53527

5614 US Highway 51
McFarland, WI 53558
Phone (608) 838-8242

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kristian Randall Krentz Individual Corporate Director Nov 25, 2019
Cynthia McGlynn Individual Corporate Director Nov 27, 2023
Aaron T Schwaab Individual Corporate Director Nov 27, 2017
Michelle Anne Abey Individual Corporate OfficerChief Financial Officer Jul 9, 2018
W-2 Managing Employee Jul 9, 2018
Glenn J Kruser Individual Corporate Director Jan 26, 2022
Nicholas John Probst Individual Corporate Director Nov 25, 2019
Timothy P Rusch Individual Corporate Director Nov 23, 2020
Ashish M Rawal Individual Corporate Director Nov 29, 2021
Susan Vanderbilt Individual Corporate Director Nov 28, 2022
Matthew Kinsella Individual Corporate Director Aug 19, 2021
Steven Peotter Individual Corporate Director Nov 27, 2023
Dawit Tesfasilassie Individual Corporate Director Aug 17, 2023
SSM Health Care of Wisconsin Inc Organization, Madison, WI Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Feb 6, 2003 40%
Christopher P Brabant Individual Corporate OfficerCeo Nov 25, 2024
W-2 Managing EmployeeCeo Nov 25, 2024
Donna Olson Individual Corporate DirectorBoard Chair Nov 26, 2018

Owners & managing parties with NPI records 7

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

Facilities with the same owner 10

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 27

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 27

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1437296456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RIDGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891864",
            "telephone_number": "608-873-6611",
            "fax_number": "608-873-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RIDGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891864",
            "telephone_number": "608-873-6611",
            "fax_number": "608-873-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOUGHTON HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STOUGHTON HOSPITAL ASSOCIATION",
        "enumeration_date": "2007-01-31",
        "last_updated": "2022-07-21",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-873-2250",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11007200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11007210",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoughton, WI

Sources for this page

Verify at the official NPI Registry.