NPIMap

Organization Active NPI

Grant Regional Health Center, Inc

Doing business as Potosi Tennyson Medical Clinic

  • Rural Health Clinic/Center
  • Potosi, WI
National Provider Identifier
1699724443
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
GRANT REGIONAL HEALTH CENTER, INC
Doing business as
Potosi Tennyson Medical Clinic
Practice address
114 US Highway 61 N
Potosi, WI 53820-9502
Phone
(608) 723-2131
NPI assigned
May 9, 2006
Last updated
Jun 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GRANT REGIONAL HEALTH CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 14, 2022

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

114 US Highway 61 N
Potosi, WI 53820-9502

Mailing address

114 US Highway 61 N
Potosi, WI 53820-9502

Other identifiers 1

IdentifierTypeStateIssuer
100192052MedicaidWI

Other names 1

  • Potosi Tennyson Medical Clinic Doing business as

Medicare participation

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

Enrollment records 2

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
O20210325001606 WI Part A Provider - Rural Health Clinic 9638079445 Practice locations: Potosi, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699724443. Details of each certification follow.

Rural health clinic certification: CCN 528628

Legal name
GRANT REGIONAL HEALTH CENTER INC
Doing business as
POTOSI-TENNYSON MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 5, 2021
Last certification
Oct 5, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1995 in WI
Enrollment address
114 US Highway 61 N
Potosi, WI 53820-9502
Related CCNs
521322

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

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Part of
Potosi-Tennyson Med CL

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Sarah Kirschbaum Individual Corporate Director May 24, 2022
Kris a Wolf Individual Corporate DirectorBoard of Directors Trustee May 30, 2017
Eric E Stader Individual Corporate Director Jan 1, 2024
Craig Bierman Individual Corporate DirectorBoard of Directors Trustee May 28, 2019
Tamara a Chambers Individual Corporate Officer Jun 1, 2024
W-2 Managing EmployeeCeo Jun 1, 2024
Andy Buttles Individual Corporate DirectorBoard of Directors Trustee May 28, 2019
Joel M Gehling Individual Corporate Officer Jul 1, 2021
W-2 Managing EmployeeCfo Jul 1, 2021
Richard J Dhyanchand Individual Corporate DirectorBoard of Directors Trustee May 26, 2020
Jason T Kenney Individual Corporate DirectorBoard of Directors Trustee May 26, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655164800000",
    "number": "1699724443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 US HIGHWAY 61 N",
            "city": "POTOSI",
            "state": "WI",
            "postal_code": "538209502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 US HIGHWAY 61 N",
            "city": "POTOSI",
            "state": "WI",
            "postal_code": "538209502",
            "telephone_number": "608-723-2131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANT REGIONAL HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GRANT REGIONAL HEALTH CENTER, INC",
        "enumeration_date": "2006-05-09",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100192052",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Potosi Tennyson Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Potosi Tennyson Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Potosi, WI

Sources for this page

Verify at the official NPI Registry.