Agnesian Healthcare, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

AGNESIAN HEALTHCARE, INC

Doing business as

SSM Health St Agnes Hospital

Practice address

430 E Division St
Fond Du Lac, WI 54935-4560

Phone

(920) 929-2300

Fax

(920) 926-8885

NPI assigned

Jan 6, 2006

Last updated

Mar 12, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Steven Little

Title

SVP & Cfo

Phone

(920) 926-5402

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• SSM HEALTH ST AGNES HOSPITAL Doing business as

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": "1578541785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-4472",
            "fax_number": "920-926-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-929-2300",
            "fax_number": "920-926-8885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGNESIAN HEALTHCARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-06",
        "last_updated": "2022-03-12",
        "certification_date": "2022-03-12",
        "status": "A",
        "authorized_official_last_name": "LITTLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_title_or_position": "SVP  & CFO",
        "authorized_official_telephone_number": "920-926-5402"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "547140",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20182100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VESTICA",
            "identifier": "101159",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM HEALTH ST AGNES HOSPITAL",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Agnesian Healthcare Inc (Fond Du Lac Regional Clinic)
• Agnesian Healthcare, Inc (St Agnes Hospital Home Infusion)
• Agnesian Healthcare, Inc (SSM Health St Agnes Hospital Fond Du Lac)
• Agnesian Healthcare, Inc (St Agnes Hospital Physical Rehab)
• Agnesian Healthcare, Inc
• Agnesian Healthcare, Inc (SSM Health Behavioral Health)
• Agnesian Healthcare, Inc (SSM Health at Home Home Health Fond Du Lac)
• Agnesian Healthcare, Inc (St Agnes Hospital Hospice Hope)
• Kabir Ahmed, M.D.
• Jennifer Ajide

• Skilled Nursing Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2022; 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.