NPIMap

Organization Active NPI

Orthopaedic Hospital of Wisconsin, LLC

Doing business as Orthopaedic Hospital of Wisconsin

  • General Acute Care Hospital
  • Glendale, WI
National Provider Identifier
1669584983
Registry record updated Aug 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
1006 Issued in WI
Legal business name
ORTHOPAEDIC HOSPITAL OF WISCONSIN, LLC
Doing business as
Orthopaedic Hospital of Wisconsin
Practice address
475 W River Woods Pkwy
Glendale, WI 53212-1081
Phone
(414) 961-6800
Fax
(414) 961-6778
NPI assigned
Aug 31, 2006
Last updated
Aug 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2023

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

Authorized official

Name
Brandon G GoldbeckNPI 1578563979
Title
Chief Executive Officer
Phone
(414) 961-6846

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 1006 WI Primary

Addresses

Primary practice location

475 W River Woods Pkwy
Glendale, WI 53212-1081

Mailing address

475 W River Woods Pkwy
Glendale, WI 53212-1081
Phone (414) 961-6800

Other identifiers 5

IdentifierTypeStateIssuer
137685900OtherU.S. DEPT. OF LABOR
7375295OtherAETNA PIN
11023600MedicaidWI
200490820AMedicaidIN
2076664OtherUNITED HEALTH CARE

Other names 1

  • Orthopaedic Hospital of Wisconsin Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20091028000252 WI Part A Provider - Hospital 4981741709 Practice locations: Wauwatosa, WI; Shorewood, WI; Saukville, WI; New Berlin, WI; Greenfield, WI; Glendale, WI; Cedarburg, WI; Mequon, WI
O20160106001182 WI Part B Supplier - Clinic/Group Practice 4981741709 Receives reassigned benefits from 62 practitioners
Practice locations: Glendale, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669584983. Details of each certification follow.

Hospital certification: CCN 520194

Legal name
ORTHOPAEDIC HOSPITAL OF WISCONSIN, LLC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Oct 12, 2001
Last certification
Aug 3, 2022
Beds
30
Ownership / control type
Physician ownership
Organization structure
LLCProprietary
Incorporated
Jan 25, 2001 in WI
Enrollment address
475 W River Woods Pkwy
Glendale, WI 53212-1081
Main/Primary Hospital Location
Hospital subgroups
Specialty hospital

Care Compare: Hospital

Medicare Care Compare
Listed as
Orthopaedic Hospital of WisconsinCCN 520194 · All quality measures
Type
Acute Care Hospitals
Ownership
Physician
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Orthopaedic Hospital of Wisconsin LLC2 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.

Locations

W62N204 Washington Ave
Cedarburg, WI 53012
Phone (262) 375-2195

475 W River Woods Pkwy
Glendale, WI 53212
Phone (414) 961-6700

4830 S 76th St
Greenfield, WI 53220
Phone (414) 282-9590

11025 N Port Washington Rd
Mequon, WI 53092
Phone (262) 292-0430

14999 W Beloit Rd
#B
New Berlin, WI 53151
Phone (414) 525-7116

555 Market St
Saukville, WI 53080
Phone (262) 236-7621

3970 N Oakland Ave
Ste 102
Shorewood, WI 53211
Phone (414) 279-0295

2500 N Mayfair Rd
Ste 550
Wauwatosa, WI 53226
Phone (414) 257-2525

6750 W State St
Wauwatosa, WI 53213
Phone (414) 585-3475

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Kim Spiess Individual Corporate OfficerChief Financial Officer Dec 4, 2017
W-2 Managing Employee Dec 4, 2017
Orthopaedic Group Joint Venture LLC Organization, Glendale, WI Created for acquisition, LLC 5% Or Greater Direct Ownership Interest Jun 4, 2001 50%
Rory R Wright Individual Corporate Director Sep 20, 2010
Alexander M Riordan Individual Corporate Director Jan 1, 2020
David B Kornreich Individual Corporate Director Dec 31, 2015
Brandon G Goldbeck Individual W-2 Managing Employee May 1, 2021
Ascension Wisconsin, Inc Organization, Glendale, WI Non-profit 5% Or Greater Direct Ownership Interest Jun 4, 2001 50%

Owners & managing parties with NPI records 3

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 84

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 84

Affiliated clinicians 138

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 138

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691020800000",
    "number": "1669584983",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 W RIVER WOODS PKWY",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121081",
            "telephone_number": "414-961-6800",
            "fax_number": "414-961-6778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 W RIVER WOODS PKWY",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532121081",
            "telephone_number": "414-961-6800",
            "fax_number": "414-961-6778"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ORTHOPAEDIC HOSPITAL OF WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2023-08-03",
        "certification_date": "2023-08-03",
        "status": "A",
        "authorized_official_last_name": "GOLDBECK",
        "authorized_official_first_name": "BRANDON",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "414-961-6846"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WI",
            "license": "1006",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "U.S. DEPT. OF LABOR",
            "identifier": "137685900",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA PIN",
            "identifier": "7375295",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11023600",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200490820A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "2076664",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Orthopaedic Hospital of Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Orthopaedic Hospital of Wisconsin",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glendale, WI

Sources for this page

Verify at the official NPI Registry.