NPIMap

Organization Active NPI

Grant Regional Health Center, Inc

Doing business as Grant Regional Community Clinic- Fennimore

  • Family Medicine Physician
  • Fennimore, WI
National Provider Identifier
1659060077
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GRANT REGIONAL HEALTH CENTER, INC
Doing business as
Grant Regional Community Clinic- Fennimore
Practice address
1525 Lafollette St
Fennimore, WI 53809
Phone
(608) 723-2131
NPI assigned
May 2, 2023
Last updated
May 2, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

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

Authorized official

Name
Joel Gehling
Title
Cfo
Phone
(608) 723-3202

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

1525 Lafollette St
Fennimore, WI 53809

Mailing address

507 S Monroe St
Lancaster, WI 53813-2054
Phone (608) 723-2143

Other names 1

  • Grant Regional Community Clinic- Fennimore Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040109000282 WI Part B Supplier - Clinic/Group Practice 9638079445 Receives reassigned benefits from 58 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fennimore, WI; Potosi, WI; Lancaster, WI; Cassville, WI

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2291349Grant Regional Community Clinic - Fennimore1525 Lafollette St, Fennimore, WI 53809Certificate of waiverOct 9, 2027

National Provider Directory

National Provider Directory
Tax ID family
Grant Regional Health Ctr6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

1525 Lafollette St
Fennimore, WI 53809
Phone (608) 723-2131

Practitioners & affiliated clinicians

Practitioners 52

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 52

NPI Registry JSON

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

{
    "created_epoch": "1682985600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682985600000",
    "number": "1659060077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "507 S MONROE ST",
            "city": "LANCASTER",
            "state": "WI",
            "postal_code": "538132054",
            "telephone_number": "608-723-2143",
            "fax_number": "608-723-4464"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1525 LAFOLLETTE ST",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "53809",
            "telephone_number": "608-723-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT REGIONAL HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-02",
        "last_updated": "2023-05-02",
        "certification_date": "2023-04-21",
        "status": "A",
        "authorized_official_last_name": "GEHLING",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "608-723-3202"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grant Regional Community Clinic- Fennimore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fennimore, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.