NPIMap

Organization Active NPI

Watertown Medical Center LLC

  • Medicare Defined Swing Bed Hospital Unit
  • Watertown, WI
National Provider Identifier
1699954222
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
391030310 Issued in WI
Legal business name
WATERTOWN MEDICAL CENTER LLC
Practice address
125 Hospital Dr
Watertown, WI 53098-3303
Phone
(920) 261-4210
NPI assigned
Oct 31, 2007
Organization subpart
Yes
Parent organization
LIFEPOINT HEALTH INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

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

Authorized official

Name
Johnetta Traylor
Title
Ao
Phone
(502) 596-6063

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 391030310 WI Primary

Addresses

Primary practice location

125 Hospital Dr
Watertown, WI 53098-3303

Mailing address

680 S 4TH St
Louisville, KY 40202-2407
Phone (502) 596-6063

Other identifiers 1

IdentifierTypeStateIssuer
11015400MedicaidWI

Other names 1

  • Watertown Regional Medical Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address health.information@direct.watertownregional.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160204001704 WI Part A Provider - Hospital 9537477997 Practice locations: Watertown, WI

Hospital certification: CCN 52U116

Legal name
WATERTOWN MEDICAL CENTER LLC
Doing business as
WATERTOWN REGIONAL MEDICAL CENTER
Organization structure
LLCProprietary
Incorporated
Apr 30, 2015 in WI
Enrollment address
125 Hospital Dr
Watertown, WI 53098-3303
Hospital Swing-Bed Unit
Hospital subgroups
Rehabilitation unit

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

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kindred Healthcare Operating LLC Organization, Louisville, KY LLC, Management services company, For-profit Operational/Managerial Control Dec 23, 2021 100%
Watertown Partner LLC Organization, Louisville, KY LLC, For-profit 5% Or Greater Indirect Ownership Interest May 1, 2015 80%
Brian Craven Individual Corporate OfficerSenior Vice President, Cfo Apr 12, 2022
Jacquelyn Joy Davis Individual Contracted Managing EmployeeChain Home Office Administrator Dec 16, 2023
Scott Graeser Individual Corporate OfficerVice President, Treasurer Aug 19, 2022
Dana M Rock Individual Corporate OfficerAssistant Administrator Dec 9, 2024
Johnetta M Traylor Individual Corporate OfficerAdministrator Dec 9, 2024
Greater Watertown Community Health Foundation Inc Organization, Watertown, WI Corporation, For-profit 5% Or Greater Indirect Ownership Interest Sep 1, 2015 20%
Knight Health Holdings LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 80%
Michael Joseph Bean Individual Corporate OfficerVice President, Tax Jan 21, 2022
Knight Intermediate Holdings LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 80%
Richard L Keddington Individual Contracted Managing EmployeeFacility Ceo & Administrator Sep 14, 2015
Knight Health II, LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 80%
Knight Healthcare New-D, LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Dec 23, 2021 80%
Watertown Holding Company LLC Organization, Louisville, KY LLC, Holding company, For-profit 5% Or Greater Direct Ownership Interest May 1, 2015 100%

Facilities with the same owner 97

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

View all 97

NPI Registry JSON

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

{
    "created_epoch": "1193788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750809600000",
    "number": "1699954222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "680 S 4TH ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402022407",
            "telephone_number": "502-596-6063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983303",
            "telephone_number": "920-261-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERTOWN MEDICAL CENTER LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFEPOINT HEALTH INC",
        "enumeration_date": "2007-10-31",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A",
        "authorized_official_last_name": "TRAYLOR",
        "authorized_official_first_name": "JOHNETTA",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "502-596-6063"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WI",
            "license": "391030310",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11015400",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "health.information@direct.watertownregional.com",
            "affiliation": "N",
            "address_1": "125 Hospital Dr",
            "city": "Watertown",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530983303",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Watertown Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Watertown Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watertown, WI

Sources for this page

Verify at the official NPI Registry.