NPIMap

Organization Active NPI

St Clare Memorial Hospital, Inc

  • Physical Therapist
  • Gillett, WI
National Provider Identifier
1700107844
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
Legal business name
ST CLARE MEMORIAL HOSPITAL, INC
Practice address
340 N Green Bay Ave
Gillett, WI 54124-9325
Phone
(920) 855-2823
Fax
(920) 855-6343
NPI assigned
Jun 11, 2010
Organization subpart
Yes
Parent organization
ST CLARE MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Authorized official

Name
Daniel Degroot
Title
Ceo
Phone
(920) 846-3444

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical TherapistGroup: 193400000X SINGLE SPECIALTY GROUP 225100000X Primary

Addresses

Primary practice location

340 N Green Bay Ave
Gillett, WI 54124-9325

Mailing address

855 S Main St
Oconto Falls, WI 54154-1241
Phone (920) 846-3444

Other identifiers 3

IdentifierTypeStateIssuer
1851477913OtherCMH NPI
1417188673OtherWIBURKEL NPI
11014110MedicaidWI

Other names 1

  • St Clare Memorial Hosptial Physical Therapy Gillett Health Center Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address community_memorial_hospital_transitions_of_care2201223@ewd.direct.hshs.org Direct

National Provider Directory

National Provider Directory
Tax ID family
Community Memorial Hospital Incorporated16 organizations share this tax ID, including this one
Part of
Community Memorial Hospital Incorporated

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1276214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1700107844",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "855 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541241",
            "telephone_number": "920-846-3444",
            "fax_number": "920-846-0250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 N GREEN BAY AVE",
            "city": "GILLETT",
            "state": "WI",
            "postal_code": "541249325",
            "telephone_number": "920-855-2823",
            "fax_number": "920-855-6343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST CLARE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST CLARE MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2010-06-11",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "920-846-3444"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMH NPI",
            "identifier": "1851477913",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BURKEL NPI",
            "identifier": "1417188673",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11014110",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "community_memorial_hospital_transitions_of_care2201223@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "340 N Green Bay Ave",
            "city": "Gillett",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541249325",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "St Clare Memorial Hosptial Physical Therapy Gillett Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St Clare Memorial Hosptial Physical Therapy Gillett Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gillett, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.