NPIMap

Organization Active NPI

Fort Healthcare, Inc.

  • General Acute Care Hospital
  • Fort Atkinson, WI
National Provider Identifier
1811916281
Registry record updated Aug 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
1908-800 Issued in WI
Legal business name
FORT HEALTHCARE, INC.
Practice address
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Phone
(920) 568-5000
Fax
(920) 568-5412
NPI assigned
Jul 18, 2006
Last updated
Aug 9, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 9, 2024

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

Authorized official

Name
Mr. James J. Nelson
Title
VP Finance
Phone
(920) 568-5000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X NU
General Acute Care Hospital 282N00000X 1908-800 WI Primary

Addresses

Primary practice location

611 Sherman Ave E
Fort Atkinson, WI 53538-1960

Mailing address

PO Box 249
Fort Atkinson, WI 53538-0249
Phone (920) 568-5000

Other identifiers 2

IdentifierTypeStateIssuer
43412100MedicaidWI
11011900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040311000090 WI Part A Provider - Hospital 0840189718 1 other NPI on this enrollment
Practice locations: Fort Atkinson, WI; Whitewater, WI; Lake Mills, WI; Johnson Creek, WI; Jefferson, WI; Cambridge, WI
O20040319001411 WI Part B Supplier - Clinic/Group Practice 0840189718 Receives reassigned benefits from 307 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fort Atkinson, WI; Whitewater, WI; Watertown, WI; Lake Mills, WI; Johnson Creek, WI; Jefferson, WI; Cambridge, WI
O20070718000769 WI Part B Supplier - Clinic/Group Practice 0840189718 Receives reassigned benefits from 8 practitioners
Practice locations: Fort Atkinson, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811916281. Details of each certification follow.

Hospital certification: CCN 520071

Legal name
FORT HEALTHCARE INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 6, 2016
Beds
82
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 30, 1942 in WI
Enrollment address
611 Sherman Ave E
Fort Atkinson, WI 53538-1960
Main/Primary Hospital Location
Hospital subgroups
Acute care

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).

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Fort Memorial HospitalCCN 520071 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1520 Madison Ave
Fort Atkinson, WI 53538
Phone (920) 563-5500

212 Milwaukee Ave W
Fort Atkinson, WI 53538
Phone (920) 563-7900

200 E Tyranena Park Rd
Lake Mills, WI 53551
Phone (920) 648-3113

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
Roy Budlong Individual Corporate Director Jan 1, 2017
Kaye Prieve Individual Corporate Director Dec 16, 2024
Carla Haubenschild Individual Corporate DirectorBoard Member Jan 1, 2025
Christopher Martin Individual Corporate DirectorBoard Member Jan 1, 2022
Michael R Anderson Individual Corporate OfficerMD Jan 8, 2013
Jeffrey a Cichocki Individual Limited Partnership Interest Jan 1, 2025
James Fitzpatrick Individual Corporate Director Jan 1, 2017
Billie G Kontny Individual Corporate Director Mar 1, 2018
Christi Renee Ott Individual Corporate Director Jan 1, 2025
Paul William Schuppner Individual Corporate DirectorBoard Member Jan 1, 2022
Stephanie L Nottestad Individual Corporate Director Jan 1, 2019
Roberta Jo Wedl Individual Corporate Director Jan 1, 2025
James J Nelson Individual Corporate Officer Apr 28, 1998
Corporate Director Mar 22, 2004
W-2 Managing Employee Jan 1, 2000
Lesley Baird Chapin Individual Corporate DirectorBoard Member Jan 1, 2024
Thomas Vinz Individual Corporate Director Jan 1, 2018

Owners & managing parties with NPI records 7

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

Practitioners & affiliated clinicians

Practitioners 116

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 116

Affiliated clinicians 378

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

View all 378

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723161600000",
    "number": "1811916281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 249",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535380249",
            "telephone_number": "920-568-5000",
            "fax_number": "920-568-5412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SHERMAN AVE E",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381960",
            "telephone_number": "920-568-5000",
            "fax_number": "920-568-5412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FORT HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-18",
        "last_updated": "2024-08-09",
        "certification_date": "2024-08-09",
        "status": "A",
        "authorized_official_last_name": "NELSON",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "920-568-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WI",
            "license": "1908-800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43412100",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11011900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Atkinson, WI

Sources for this page

Verify at the official NPI Registry.