NPIMap

Organization Active NPI

Wound Care of Wisconsin LLC

  • Primary Care Clinic/Center
  • Waupun, WI
National Provider Identifier
1669296364
Registry record updated Nov 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
WOUND CARE OF WISCONSIN LLC
Practice address
160 Gateway Dr
Waupun, WI 53963-2276
Phone
(920) 324-9899
NPI assigned
Nov 11, 2024
Last updated
Nov 21, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2024

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

Authorized official

Name
Randall Blohowiak, DCNPI 1356301188
Title
Owner
Phone
(920) 324-9899

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X NU
Primary Care Clinic/Center 261QP2300X NU Primary
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

160 Gateway Dr
Waupun, WI 53963-2276

Mailing address

160 Gateway Dr
Waupun, WI 53963-2276
Phone (920) 324-9899

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241121002321 WI Part B Supplier - Clinic/Group Practice 5092240457 Receives reassigned benefits from 3 practitioners
Practice locations: Waupun, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1731283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732147200000",
    "number": "1669296364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "160 GATEWAY DR",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539632276",
            "telephone_number": "920-324-9899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOUND CARE OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-11-11",
        "last_updated": "2024-11-21",
        "certification_date": "2024-11-13",
        "status": "A",
        "authorized_official_last_name": "BLOHOWIAK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-324-9899",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2024; 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.