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Organization Active NPI

Stoughton Hospital Association

  • Critical Access Hospital
  • Stoughton, WI
National Provider Identifier
1679558647
Registry record updated Nov 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
3804800 Issued in WI
Legal business name
STOUGHTON HOSPITAL ASSOCIATION
Practice address
900 Ridge St
Stoughton, WI 53589-1864
Phone
(608) 873-6611
Fax
(608) 873-2255
NPI assigned
Dec 13, 2005
Reactivated
Nov 19, 2015
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Daniel C Degroot
Title
President
Phone
(608) 873-2250

Owners & managing parties with NPI records 7

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

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 2

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

Member of 1

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

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

Facilities with the same owner 10

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

Practitioners 241

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 241

Affiliated clinicians 344

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

View all 344

Care Compare: Hospital

Medicare Care Compare
Listed as
Stoughton HospitalCCN 521343
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Hospital certification: CCN 521343

Medicare enrollment files
Legal name
STOUGHTON HOSPITAL ASSOCIATION
Doing business as
STOUGHTON HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Oct 1, 2004
Last certification
Feb 2, 2017
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 9, 1924 in WI
Enrollment address
900 Ridge St
Stoughton, WI 53589-1864
Main/Primary Hospital Location

All disclosed owners & managing parties 15

Medicare enrollment files

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

NameRoleSinceShare
Kristian Randall Krentz Individual Corporate Director Nov 25, 2019
Cynthia McGlynn Individual Corporate Director Nov 27, 2023
Aaron T Schwaab Individual Corporate Director Nov 27, 2017
Michelle Anne Abey Individual Corporate OfficerCfo Jul 9, 2018
W-2 Managing EmployeeCfo Jul 1, 2015
Daniel C Degroot Individual Corporate OfficerChief Executive Officer May 7, 2018
W-2 Managing EmployeeChief Executive Officer May 7, 2018
Glenn J Kruser Individual Corporate Director Jan 26, 2022
Nicholas John Probst Individual Corporate Director Nov 25, 2019
Timothy P Rusch Individual Corporate Director Nov 23, 2020
Ashish M Rawal Individual Corporate Director Nov 29, 2021
Susan Vanderbilt Individual Corporate Director Nov 28, 2022
Matthew Kinsella Individual Corporate Director Aug 19, 2021
Steven Peotter Individual Corporate Director Nov 27, 2023
Dawit Tesfasilassie Individual Corporate Director Aug 17, 2023
SSM Health Care of Wisconsin Inc Organization, Madison, WI Corporation, Medical provider/supplier, Non-profit 5% Or Greater Direct Ownership Interest Feb 6, 2003 40%
Donna Olson Individual Corporate Director Nov 26, 2018

Medicare enrollment records 3

Medicare enrollment files
Enrollment IDStateProvider typePAC IDDetails
O20040402001358 WI Part B Supplier - Clinic/Group Practice 7012825706 Receives reassigned benefits from 109 practitioners
4 other NPIs on this enrollment
Practice locations: Stoughton, WI; Oregon, WI; McFarland, WI; Cottage Grove, WI
O20040402001391 WI Part B Supplier - Clinic/Group Practice 7012825706 Receives reassigned benefits from 12 practitioners
Practice locations: Oregon, WI; Stoughton, WI
O20100106000471 WI Part a Provider - Critical Access Hospital 7012825706 Receives reassigned benefits from 102 practitioners
2 other NPIs on this enrollment
Practice locations: McFarland, WI; Oregon, WI; Stoughton, WI

National Provider Directory

National Provider Directory

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 3804800 WI Primary
Psychiatric Hospital 283Q00000X 3804800 WI

Addresses

NPPES NPI Registry

Primary practice location

900 Ridge St
Stoughton, WI 53589-1864

Mailing address

900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-6611

Other identifiers 4

NPPES NPI Registry
IdentifierTypeStateIssuer
11007210MedicaidWI
78OtherWIDEAN HEALTH PLAN
1009393OtherWIPHYSICIANS PLUS HEALTH IN
11007200MedicaidWI

Electronic endpoints 2

NPPES NPI Registry
TypeEndpointUseAffiliation
FHIR URL https://fhir.ssmh.com/fhir/api/FHIR/DSTU2 Other
Direct Messaging Address aschwaab263161@direct-ehr-ssmhc.com Direct

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Nov 13, 2020.

{
    "created_epoch": "1134432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1605225600000",
    "number": "1679558647",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 RIDGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891864",
            "telephone_number": "608-873-6611",
            "fax_number": "608-873-2255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 RIDGE ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535891864",
            "telephone_number": "608-873-6611",
            "fax_number": "608-873-2255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOUGHTON HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-13",
        "last_updated": "2020-11-13",
        "certification_date": "2020-10-21",
        "deactivation_date": "2015-11-06",
        "reactivation_date": "2015-11-19",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "608-873-2250",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "3804800",
            "primary": true
        },
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": "WI",
            "license": "3804800",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11007210",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "78",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS HEALTH IN",
            "identifier": "1009393",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11007200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://fhir.ssmh.com/fhir/api/FHIR/DSTU2",
            "affiliation": "N",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "FHR API",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "900 Ridge St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891864",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aschwaab263161@direct-ehr-ssmhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "aschwaab263161@direct-ehr-ssmhc.com",
            "address_1": "900 Ridge St",
            "city": "Stoughton",
            "state": "WI",
            "country_code": "US",
            "postal_code": "535891864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stoughton, WI

Sources for this page

Verify at the official NPI Registry.