NPIMap

Organization Active NPI

Dean Health Systems, Inc

Doing business as SSM Health Dean Medical Group - Portage

  • Durable Medical Equipment & Medical Supplies
  • Portage, WI
National Provider Identifier
1760593545
Registry record updated Aug 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
DEAN HEALTH SYSTEMS, INC
Doing business as
SSM Health Dean Medical Group - Portage
Practice address
2825 Hunters TRL
2ND Floor
Portage, WI 53901
Phone
(608) 742-1063
Fax
(608) 745-3750
NPI assigned
Aug 31, 2006
Last updated
Aug 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2020

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

Authorized official

Name
Amy J Grinnell
Title
Vice President - Finance
Phone
(608) 260-3586

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

2825 Hunters TRL
2ND Floor
Portage, WI 53901

Mailing address

2825 Hunters TRL
2ND Floor
Portage, WI 53901-3429
Phone (608) 742-1063

Other names 1

  • SSM Health Dean Medical Group - Portage Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930061993 WI DME Supplier - Multi-Specialty - Physician 7012827983 Practice locations: Portage, WI

Other NPIs with the same Medicare PAC ID 20

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

View all 20

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0393950SSM Health Dean Medical Group -Portage2825 Hunters Trail, Portage, WI 53901ComplianceMay 19, 2027

National Provider Directory

National Provider Directory
Tax ID family
Dean Health Systems Dea27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596412800000",
    "number": "1760593545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2825 HUNTERS TRL",
            "address_2": "2ND FLOOR",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "539013429",
            "telephone_number": "608-742-1063",
            "fax_number": "608-745-3750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2825 HUNTERS TRL",
            "address_2": "2ND FLOOR",
            "city": "PORTAGE",
            "state": "WI",
            "postal_code": "53901",
            "telephone_number": "608-742-1063",
            "fax_number": "608-745-3750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEAN HEALTH SYSTEMS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2020-08-03",
        "certification_date": "2020-08-03",
        "status": "A",
        "authorized_official_last_name": "GRINNELL",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT - FINANCE",
        "authorized_official_telephone_number": "608-260-3586"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Dean Medical Group - Portage",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portage, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.