NPIMap

Organization Active NPI

Mercy Health System Corporation

  • Critical Access Hospital
  • Lake Geneva, WI
National Provider Identifier
1699728550
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1062 Issued in WI
Legal business name
MERCY HEALTH SYSTEM CORPORATION
Practice address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Phone
(262) 245-0535
Fax
(262) 245-2198
NPI assigned
May 19, 2006
Organization subpart
Yes
Parent organization
MERCY HEALTH CORPORATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Authorized official

Name
Shannon Dunphy-Alexander
Title
Cfo
Phone
(608) 757-3126

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X 310-800 WI
Physical Therapy Clinic/Center 261QP2000X 3108-800 WI
Critical Access Hospital 282NC0060X 1062 WI Primary
Durable Medical Equipment & Medical Supplies 332B00000X 310800 WI

Addresses

Primary practice location

N2950 State Road 67
Lake Geneva, WI 53147-2655

Mailing address

1000 Mineral Point Ave
Janesville, WI 53548-2940
Phone (608) 756-6000

Other identifiers 1

IdentifierTypeStateIssuer
11024910MedicaidWI

Other names 1

  • MERCY WALWORTH HOSPITAL AND MEDICAL CENTER Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210611000108 WI Part A Provider - Critical Access Hospital 7416860440 Receives reassigned benefits from 257 practitioners
Practice locations: Lake Geneva, WI

Hospital certification: CCN 521357

Legal name
MERCY HEALTH SYSTEM CORPORATION
Doing business as
MERCY WALWORTH HOSPITAL & MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 29, 2005
Last certification
Jul 9, 2009
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
N2950 State Road 67
Lake Geneva, WI 53147-2655
Other Hospital Practice Location

Other NPIs with the same Medicare PAC ID 13

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

View all 13

National Provider Directory

National Provider Directory

Locations

2230 Huntington Dr N
Algonquin, IL 60102
Phone (847) 603-4146

450 W Highway 22
Ste 150
Barrington, IL 60010
Phone (815) 382-1505

500 W Highway 22
Ste 150
Barrington, IL 60010
Phone (847) 382-1505

730 E Terra Cotta Ave
Ste B
Crystal Lake, IL 60014
Phone (815) 344-2034

914 State Route 22
Fox River Grv, IL 60021
Phone (847) 639-9600

1 S Greenleaf St
Ste L
Gurnee, IL 60031
Phone (847) 263-0764

250 Center Dr
Vernon Hills, IL 60061
Phone (847) 549-6100

3707 Doty Rd
Ste 2
Woodstock, IL 60098
Phone (815) 334-3100

1065 Lake Ave
Woodstock, IL 60098
Phone (815) 338-4600

3055 S Riverside Dr
Beloit, WI 53511
Phone (608) 365-7222

5 N Water St
Evansville, WI 53536
Phone (608) 882-5700

109 S Atwood Ave
Janesville, WI 53545
Phone (608) 752-6709

557 N Washington St
Janesville, WI 53548
Phone (608) 754-6000

3524 E Milwaukee St
Rm 110
Janesville, WI 53546
Phone (608) 754-8097

569 Broad St
Lake Geneva, WI 53147
Phone (262) 249-0221

4410 Regent St
Madison, WI 53705
Phone (608) 233-9746

725 S Janesville St
Ste 100
Milton, WI 53563
Phone (608) 868-2758

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Dave L Syverson Individual Corporate Director Nov 14, 2005
Hannah Engelkes Individual W-2 Managing EmployeeCredentialing & Enrollment Manager Dec 1, 2025
Kathi J Palches Individual W-2 Managing EmployeeFacility Credentialing Coordinator Oct 6, 2010
Ali Olia Individual Corporate OfficerVP Information Systems May 16, 2022
W-2 Managing EmployeeVP Information Systems Nov 1, 2021
Steven John Meyer Individual W-2 Managing EmployeeEnrollment Lead Dec 1, 2025
Shannon Dunphy-Alexander Individual Corporate OfficerCfo Mar 27, 2026
W-2 Managing Employee Mar 11, 2018
Kara Sankey Individual Corporate OfficerVP Operations May 16, 2022
W-2 Managing EmployeeVP Operations Apr 1, 2021
Jennifer a Hallatt Individual Corporate OfficerVP Jan 1, 2012
W-2 Managing EmployeeVP Jan 1, 2012
Carlos Arevalo Individual Corporate DirectorBoard Member Oct 16, 2024
Mercy Health Corporation Organization, Rockford, IL Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Jan 1, 2016 100%
Operational/Managerial Control Jan 1, 2016 100%
Thomas D Budd Individual Corporate DirectorBoard of Directors-Secretary/Tre Jan 1, 2016
John T Dorsey Individual Corporate OfficerVP & Director of Medical Affairs Aug 20, 2012
W-2 Managing EmployeeVP & Director of Medical Affairs Aug 20, 2012
Katherine a Schack Individual Corporate DirectorBoard of Directors - Vice Chair Mar 22, 2017
Joanna Benning Individual Corporate OfficerVP Operations Mar 15, 2015
W-2 Managing EmployeeVP Operations Mar 15, 2015
Edward P Cranley Individual Corporate OfficerVP Mercycare Insurance Nov 30, 2014
W-2 Managing EmployeeVP Mercycare Insurance Nov 30, 2014
Bradley Olson Individual Corporate OfficerVP Managed Care Sep 25, 2023
W-2 Managing EmployeeVP Managed Care Sep 25, 2023
Mark L Goelzer Individual Corporate OfficerVP & Director of Medical Affairs Jan 1, 2016
Corporate DirectorBoard of Directors Nov 14, 2005
W-2 Managing EmployeeVP & Director of Medical Affairs Jan 1, 2016
Wesley M Jost Individual Corporate DirectorBoard of Directors Jul 1, 2016
Tyler Killpack Individual Corporate OfficerVP Community Hospitals Aug 1, 2023
W-2 Managing EmployeeVP Community Hospitals Aug 1, 2023
Amy Whitaker Individual Corporate OfficerVP Supply Chain Aug 1, 2022
W-2 Managing EmployeeVP Supply Chain Aug 1, 2022
Thomas R Pool Individual Corporate DirectorBoard of Director-Chair Nov 14, 2005
Ladd Udy Individual Corporate OfficerVP Value Based Care & Pop Health Nov 10, 2018
W-2 Managing EmployeeP Value Based Care & Pop Health Nov 10, 2018
Javon R Bea Individual Corporate OfficerPresident/Ceo Jul 27, 1989
Corporate DirectorPresident/Ceo Jul 27, 1989

Owners & managing parties with NPI records 2

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

Facilities with the same owner 14

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

View all 14

Practitioners 1,662

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

View all 1,662

Affiliated clinicians 209

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

View all 209

Care Compare: Hospital

Medicare Care Compare
Listed as
Mercy Walworth Hospital & Medical CenterCCN 521357
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

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1699728550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MINERAL POINT AVE",
            "city": "JANESVILLE",
            "state": "WI",
            "postal_code": "535482940",
            "telephone_number": "608-756-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2950 STATE ROAD 67",
            "city": "LAKE GENEVA",
            "state": "WI",
            "postal_code": "531472655",
            "telephone_number": "262-245-0535",
            "fax_number": "262-245-2198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH SYSTEM CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH CORPORATION",
        "enumeration_date": "2006-05-19",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "DUNPHY-ALEXANDER",
        "authorized_official_first_name": "SHANNON",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "608-757-3126"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": "WI",
            "license": "310-800",
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": "WI",
            "license": "3108-800",
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "1062",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": "310800",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11024910",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MERCY WALWORTH HOSPITAL AND MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MERCY WALWORTH HOSPITAL AND MEDICAL CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Geneva, WI

Sources for this page

Verify at the official NPI Registry.