NPIMap

Organization Active NPI

Door County Memorial Hospital

Doing business as Door County Medical Center Sturgeon Bay

  • Rural Health Clinic/Center
  • Sturgeon Bay, WI
National Provider Identifier
1578892857
Registry record updated Apr 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
DOOR COUNTY MEMORIAL HOSPITAL
Doing business as
Door County Medical Center Sturgeon Bay
Practice address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone
(920) 743-5566
NPI assigned
Dec 15, 2009
Last updated
Apr 6, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2022

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

Authorized official

Name
Mr. Andrew S Laluzerne
Title
Cfo
Phone
(920) 746-3729

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

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

Mailing address

323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Phone (920) 743-5566

Other names 1

  • Door County Medical 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
O20081106000547 WI Part A Provider - Rural Health Clinic 5395735088 1 other NPI on this enrollment
Practice locations: Sturgeon Bay, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578892857. Details of each certification follow.

Rural health clinic certification: CCN 528531

Legal name
DOOR COUNTY MEMORIAL HOSPITAL
Doing business as
DOOR COUNTY MEDICAL CENTER STURGEON BAY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 21, 2009
Last certification
Jun 6, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 16, 1944 in WI
Enrollment address
323 S 18TH Ave
Sturgeon Bay, WI 54235-1401
Related CCNs
521358

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

Other NPIs with the same Medicare PAC ID 7

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.

National Provider Directory

National Provider Directory
Tax ID family
Michael Brunobay PT CL16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Edgar K Collison Individual Corporate DirectorBoard Member May 14, 2025
Patricia M Vickman Individual Corporate DirectorBoard Member Oct 1, 2017
Pauline M Helm Individual Corporate DirectorBoard Member Jan 1, 2023
Andrew S Laluzerne Individual Corporate OfficerCfo Oct 29, 2018
Joseph Joshua Rebhan Individual Corporate DirectorBoard Member Jan 1, 2026
Martha S Ziegelbauer Individual Corporate DirectorBoard Member Jan 1, 2022
Michael R St Jean Individual Corporate DirectorBoard Member Jan 1, 2025
Jamie D Alberts Individual Corporate DirectorBoard Member Jan 1, 2021
Tammy a Sternard Individual Corporate DirectorBoard Member Jan 1, 2025
Joel C Kitchens Individual Corporate DirectorBoard Member Jan 1, 2021
St Vincent Hospital-Hospital Sisters-Third Order of St Francis Organization, Green Bay, WI Corporation, Non-profit Operational/Managerial Control Nov 1, 2016 40%
Erin Rae Helgeson Individual Corporate DirectorBoard Member Jan 1, 2024
Dorene E Dempster Individual Corporate DirectorBoard Member/Medical Staff Presiden Jan 1, 2019
Bradley S Andreae Individual Corporate DirectorBoard Member Jan 1, 2024
Jeffrey J Rabas Individual Corporate DirectorBoard Member Jan 1, 2022
Jonathan L Jarosh Individual Corporate DirectorBoard Member Jan 1, 2024
Robert Erickson Individual Corporate DirectorBoard Member May 15, 2024
Brian C Stephens Individual Corporate OfficerCeo Jan 6, 2019
Operational/Managerial ControlCeo Jan 6, 2019
Corwin D Dahl Individual Corporate DirectorBoard Member Jan 1, 2021
Andrew Richmond Individual Corporate DirectorBoard Member Oct 1, 2017

Owners & managing parties with NPI records 19

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

View all 19

Facilities with the same owner 8

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

NPI Registry JSON

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

{
    "created_epoch": "1260835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649203200000",
    "number": "1578892857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 S 18TH AVE",
            "city": "STURGEON BAY",
            "state": "WI",
            "postal_code": "542351401",
            "telephone_number": "920-743-5566"
        },
        {
            "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": "920-743-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOOR COUNTY MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-15",
        "last_updated": "2022-04-06",
        "certification_date": "2022-04-06",
        "status": "A",
        "authorized_official_last_name": "LALUZERNE",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-746-3729",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Door County Medical Center Sturgeon Bay",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sturgeon Bay, WI

Sources for this page

Verify at the official NPI Registry.