NPIMap

Organization Active NPI

St. Clare Memorial Hospital, Inc

Doing business as HSHS SCO Regional Surgery Center Sturgeon Bay

  • Surgery Physician
  • Sturgeon Bay, WI
National Provider Identifier
1447618152
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST. CLARE MEMORIAL HOSPITAL, INC
Doing business as
HSHS SCO Regional Surgery Center Sturgeon Bay
Practice address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone
(920) 965-7411
NPI assigned
Feb 9, 2016
Last updated
Feb 9, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. CLARE MEMORIAL HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

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

Authorized official

Name
Daniel Degroot
Title
Coo
Phone
(920) 846-4581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401

Mailing address

853 S Main St
Oconto Falls, WI 54154-1241
Phone (920) 965-7411

Other names 1

  • HSHS SCO Regional Surgery Center Sturgeon Bay Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041023000037 WI Part B Supplier - Clinic/Group Practice 0446211395 Receives reassigned benefits from 239 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Green Bay, WI; Suring, WI; Sturgeon Bay, WI; Oconto Falls, WI; Mountain, WI; Marinette, WI; Lena, WI; Gillett, WI

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hosp16 organizations share this tax ID, including this one
Part of
Community Memorial Hosp

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1454976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1447618152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541241",
            "telephone_number": "920-965-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-965-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLARE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. CLARE MEMORIAL HOSPITAL, INC.",
        "enumeration_date": "2016-02-09",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "920-846-4581"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HSHS SCO Regional Surgery Center Sturgeon Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sturgeon Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.