NPIMap

Organization Active NPI

SSM Health Care of Wisconsin Inc

  • Registered Dietitian
  • Baraboo, WI
National Provider Identifier
1467435214
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered DietitianTaxonomy code 133V00000X
Legal business name
SSM HEALTH CARE OF WISCONSIN INC
Practice address
707 14TH St
Baraboo, WI 53913-1539
Phone
(608) 356-1400
NPI assigned
Nov 25, 2005
Last updated
Oct 19, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
SSM HEALTH ST CLARE HOSPITAL-BARABOOAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Authorized official

Name
Troy Walker
Title
Director of Finance
Phone
(608) 356-1400

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Dietitian 133V00000X NU Primary

Addresses

Primary practice location

707 14TH St
Baraboo, WI 53913-1539

Mailing address

707 14TH St
Baraboo, WI 53913-1539
Phone (608) 356-1400

Other identifiers 4

IdentifierTypeStateIssuer
1009390OtherWIPHYS PLUS PROV #
391023846OtherWICOMMERICAL INS PROV #
11022800MedicaidWI
391023846028OtherWIBLUE CROSS PROV #

National Provider Directory

National Provider Directory
Part of
Rocco J Fiordelisi MD

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1132876800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1476835200000",
    "number": "1467435214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131539",
            "telephone_number": "608-356-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131539",
            "telephone_number": "608-356-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SSM HEALTH CARE OF WISCONSIN INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SSM HEALTH ST CLARE HOSPITAL-BARABOO",
        "enumeration_date": "2005-11-25",
        "last_updated": "2016-10-19",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "608-356-1400"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYS PLUS PROV #",
            "identifier": "1009390",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERICAL INS PROV #",
            "identifier": "391023846",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11022800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROV #",
            "identifier": "391023846028",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baraboo, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; 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.