NPIMap

Organization Active NPI

Waupun Memorial Hospital

Doing business as Fond Du Lac Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fond Du Lac, WI
National Provider Identifier
1619955838
Registry record updated Mar 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WAUPUN MEMORIAL HOSPITAL
Doing business as
Fond Du Lac Dialysis Center
SSM Health Dialysis Center
Practice address
101 S Pioneer Rd
Fond Du Lac, WI 54935-3871
Phone
(920) 923-2333
Fax
(920) 926-8885
NPI assigned
Jan 6, 2006
Last updated
Mar 12, 2022By the provider in NPPES
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
Steven N Little
Title
SVP & Cfo
Phone
(920) 926-5402

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

101 S Pioneer Rd
Fond Du Lac, WI 54935-3871

Mailing address

PO Box 1283
Fond Du Lac, WI 54936-1283
Phone (920) 926-4472

Other identifiers 3

IdentifierTypeStateIssuer
42052300OtherWIWI CHRONIC DISEASE PROGRA
Z3OtherWIDEAN CARE
42052300MedicaidWI

Other names 2

  • FOND DU LAC DIALYSIS CENTER Doing business as
  • SSM Health Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120106000251 WI Part A Provider - End-Stage Renal Disease Facility (ESRD) 7618886565 Practice locations: Fond Du Lac, WI

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Waupin Memorial Hospita2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Member of 2

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

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": "1619955838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1283",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549361283",
            "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": "101 S PIONEER RD",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353871",
            "telephone_number": "920-923-2333",
            "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": "LITTLE",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "SVP & CFO",
        "authorized_official_telephone_number": "920-926-5402"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI CHRONIC DISEASE PROGRA",
            "identifier": "42052300",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "Z3",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42052300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOND DU LAC DIALYSIS CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SSM Health Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

  • 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.
  • 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.