NPIMap

Organization Active NPI

Memorial Medical Center Inc

  • Psychiatric Hospital Unit
  • Ashland, WI
National Provider Identifier
1801005210
Registry record updated Nov 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
License
275 Issued in WI
Legal business name
MEMORIAL MEDICAL CENTER INC
Practice address
1615 Maple LN
Ashland, WI 54806-3610
Phone
(715) 685-5500
Fax
(715) 685-5118
NPI assigned
May 22, 2007
Reactivated
Sep 10, 2008
Organization subpart
Yes
Parent organization
MEMORIAL MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 22, 2023

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

Authorized official

Name
Mr. Jason T Douglas
Title
President
Phone
(715) 685-5512

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X 275 WI Primary

Addresses

Primary practice location

1615 Maple LN
Ashland, WI 54806-3610

Mailing address

1615 Maple LN
Ashland, WI 54806-3610
Phone (715) 685-5500

Other identifiers 9

IdentifierTypeStateIssuer
11019526MedicaidWI
0160HMEOtherMNBLUE CROSS BLUE SHIELD
3901638OtherWIMEDICA PROF COMPONENT
11019500MedicaidWI
01022385OtherWIPREFERRED ONE
0160JMEOtherMNBLUE CROSS BLUE SHIELD
11019521MedicaidWI
36585MEOtherMNBCBS PROF COMPONENT
5025472OtherWIMEDICA

Other names 1

  • Tamarack Health Ashland 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
O20070706000128 WI Part A Provider - Critical Access Hospital 8022000447 Receives reassigned benefits from 1 practitioner
Practice locations: Ashland, WI

Hospital certification: CCN 52M359

Legal name
MEMORIAL MEDICAL CENTER INC
Doing business as
TAMARACK HEALTH ASHLAND MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Dec 9, 1968 in WI
Enrollment address
1615 Maple LN
Ashland, WI 54806-3610
Other Hospital Practice Location

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
Tax ID family
Memorial Medical Center Inc3 organizations share this tax ID, including this one
Part of
Memorial Medical Center Inc

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Thomas Jokinen Individual Corporate DirectorBoard Member Jun 7, 2007
Christine Iverson Individual Corporate DirectorBoard Member Jun 7, 2007
Dani Mikula Individual Corporate DirectorBoard Member Feb 21, 2024
Patricia Schraufnagel Individual Corporate DirectorBoard Member Jun 7, 2007
Richard Setzke Individual Corporate DirectorBoard Member Feb 21, 2024
Aistis J Tumas Individual Corporate DirectorBoard Member Feb 21, 2024
Tyler Wickman Individual Corporate DirectorBoard Member Feb 21, 2024
Taylor Pearson Individual Corporate DirectorBoard Member Feb 21, 2024
Matthew F Anich Individual Corporate DirectorBoard Member Jan 1, 1993
Peggy Vanhollen-Kman Individual Corporate DirectorBoard Member Jan 1, 2013
Robert Lee Houle Individual Corporate DirectorBoard Member Feb 21, 2024
John Smylie Individual Corporate DirectorBoard Member Feb 21, 2024
Thomas C Cunningham Individual Corporate DirectorBoard Member Jan 1, 2013
Luke Daniel Beirl Individual Corporate OfficerInterim Ceo Feb 7, 2024
W-2 Managing EmployeeInterim Ceo Feb 21, 2024
Kent J Dumonseau Individual Corporate OfficerVice President of Finance/Cfo Aug 19, 2013
W-2 Managing EmployeeVice President of Finance/Cfo Aug 19, 2013
Karen Hansen Individual Corporate DirectorBoard Member Feb 21, 2024
Regional Enterprises Inc Organization, Ashland, WI Non-profit Operational/Managerial Control Jul 2, 2007

Owners & managing parties with NPI records 1

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

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 81

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

View all 81

NPI Registry JSON

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700611200000",
    "number": "1801005210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1615 MAPLE LN",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548063610",
            "telephone_number": "715-685-5500",
            "fax_number": "715-685-5118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 MAPLE LN",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548063610",
            "telephone_number": "715-685-5500",
            "fax_number": "715-685-5118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL MEDICAL CENTER INC",
        "enumeration_date": "2007-05-22",
        "last_updated": "2023-11-22",
        "certification_date": "2023-11-22",
        "deactivation_date": "2008-02-01",
        "reactivation_date": "2008-09-10",
        "status": "A",
        "authorized_official_last_name": "DOUGLAS",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-685-5512",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "WI",
            "license": "275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11019526",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0160HME",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA PROF COMPONENT",
            "identifier": "3901638",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11019500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "01022385",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0160JME",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11019521",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROF COMPONENT",
            "identifier": "36585ME",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5025472",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tamarack Health Ashland Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ashland, WI

Sources for this page

Verify at the official NPI Registry.