NPIMap

Organization Active NPI

Waupun Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Waupun, WI
National Provider Identifier
1528046737
Registry record updated Mar 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
WAUPUN MEMORIAL HOSPITAL
Practice address
620 W Brown St
Waupun, WI 53963-1702
Phone
(920) 324-5581
Fax
(920) 926-8885
NPI assigned
Jan 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2022

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

Authorized official

Name
Bonnie R Schmitz
Title
Cfo
Phone
(920) 926-4480

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

620 W Brown St
Waupun, WI 53963-1702

Mailing address

620 W Brown St
Waupun, WI 53963-1702
Phone (920) 324-5581

Other identifiers 3

IdentifierTypeStateIssuer
101160OtherWIVESTICA
Z3OtherWIDEAN CARE
11008100MedicaidWI

Other names 2

  • SSM Health Waupun Memorial Hospital Doing business as
  • WAUPUN MEMORIAL HOSPITAL SWINGBED Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20061104000135 WI Part A Provider - Critical Access Hospital 7618886565 Practice locations: Waupun, WI
O20070523000593 WI Part A Provider - Critical Access Hospital 7618886565 Receives reassigned benefits from 3 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Waupun, WI

Hospital certification: CCN 52Z327

Legal name
WAUPUN MEMORIAL HOSPITAL
Doing business as
SSM HEALTH WAUPUN MEMORIAL HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
May 18, 1949 in WI
Enrollment address
620 West Brown Street
Waupun, WI 53963-1702

Hospital certification: CCN 521327

Legal name
WAUPUN MEMORIAL HOSPITAL
Doing business as
SSM HEALTH WAUPUN MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2003
Last certification
Jan 9, 2019
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
May 18, 1949 in WI
Enrollment address
620W Brown St
Waupun, WI 53963-1702
Other Hospital Practice Location

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Waupun Memorial HospitalCCN 521327
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Member of 2

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Scott M Hansfield Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate DirectorBoard Member Jan 1, 2011
Katherine R Vergos Individual Corporate OfficerPresident Jan 1, 2019
W-2 Managing EmployeePresident Jan 1, 2019
Agnesian Healthcare Inc Organization, Fond Du Lac, WI Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2000 100%
Karen E Reynolds Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
John E Bett Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Carleen M Vandezande Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate DirectorDirector Jan 1, 2011
Robert V Nagle Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Troy Walker Individual Corporate Director Apr 1, 2020
W-2 Managing Employee Apr 1, 2020
Joseph Minerath Individual W-2 Managing EmployeeDirector Jan 1, 2022
SSM Health Care Corporation Organization, Saint Louis, MO Corporation, Non-profit Operational/Managerial Control Jan 1, 2018
5% Or Greater Direct Ownership Interest Jan 1, 2018 100%
Jill M Vanderkin Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
David L Hopp Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Jeffrey a Homan Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Kathleen K Hendricks Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Laura Kaiser Individual W-2 Managing EmployeeCeo Jan 1, 2018
Jon W Clark Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate DirectorBoard Member Jan 1, 2011
Roxy J Schouten Individual Corporate DirectorBoard Member Jan 1, 2018
Corporate Director Jan 1, 2017
Deann Thurmer Individual Corporate DirectorCoo Jan 1, 2011

Owners & managing parties with NPI records 18

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

View all 18

Facilities with the same owner 32

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

View all 32

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 182

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 182

NPI Registry JSON

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

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647043200000",
    "number": "1528046737",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "620 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-324-5581",
            "fax_number": "920-926-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "620 W BROWN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631702",
            "telephone_number": "920-324-5581",
            "fax_number": "920-926-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUPUN MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A",
        "authorized_official_last_name": "SCHMITZ",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-926-4480"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VESTICA",
            "identifier": "101160",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "Z3",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11008100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Waupun Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WAUPUN MEMORIAL HOSPITAL SWINGBED",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waupun, WI

Sources for this page

Verify at the official NPI Registry.