NPIMap

Organization Active NPI

Langlade Hospital - Hotel Dieu of St Joseph of Antigo Wisconsin

Doing business as Aspirus Antigo Clinic

  • Rural Health Clinic/Center
  • Antigo, WI
National Provider Identifier
1821151366
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN
Doing business as
Aspirus Antigo Clinic
Practice address
110 E 5TH Ave
Antigo, WI 54409-2710
Phone
(715) 623-2351
NPI assigned
Dec 18, 2006
Last updated
Jun 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Jerry M Yang
Title
SVP & Chief Financial Officer
Phone
(715) 847-2526

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X WI
Multi-Specialty Clinic/Center 261QM1300X NU
Rural Health Clinic/Center 261QR1300X WI Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

110 E 5TH Ave
Antigo, WI 54409-2710

Mailing address

29980 Network PL
Chicago, IL 60673-1299
Phone (715) 847-2304

Other names 1

  • Aspirus Antigo Clinic Doing business as

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040212000310 WI Part B Supplier - Clinic/Group Practice 1557271202 Receives reassigned benefits from 353 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Merrill, WI; Wittenberg, WI; Rhinelander, WI; Elcho, WI; Birnamwood, WI; Antigo, WI
O20110126000993 WI Part A Provider - Critical Access Hospital 1557271202 Receives reassigned benefits from 298 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Antigo, WI
O20170510002395 WI Part A Provider - Rural Health Clinic 1557271202 Practice locations: Antigo, WI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1821151366. Details of each certification follow.

Hospital certification: CCN 521350

Legal name
LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN
Doing business as
ASPIRUS LANGLADE HOSPTIAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 1, 2005
Last certification
Jan 18, 2005
Beds
25
Ownership / control type
Church
Organization structure
CorporationNon-profit
Incorporated
Jan 11, 1933 in WI
Enrollment address
112 E 5TH Ave
Antigo, WI 54409-2710
Main/Primary Hospital Location

Rural health clinic certification: CCN 528582

Legal name
LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN
Doing business as
ASPIRUS ANTIGO CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 30, 2017
Last certification
Oct 30, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 11, 1933 in WI
Enrollment address
110 E 5TH Ave
Antigo, WI 54409-2710
Related CCNs
521350

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

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Langlade HospitalCCN 521350 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

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
Julie a Sprague Individual Corporate DirectorBoard Member Sep 30, 2022
Jerry M Yang Individual Corporate DirectorSVP and Chief Financial Officer Feb 26, 2024
W-2 Managing EmployeeSVP and Chief Financial Offic Feb 26, 2024
Operational/Managerial ControlSVP and Chief Financial Officer Feb 26, 2024
Lakshmi Deep Individual Corporate DirectorBoard Member Oct 1, 2023
Aspirus, Inc Organization, Wausau, WI Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2008 45%
5% Or Greater Direct Ownership Interest Apr 1, 2017 45%
James Matheson Individual Corporate DirectorBoard Member Sep 30, 2020
Religious Hospitallers of St. Joseph Organization, Antigo, WI Non-profit 5% Or Greater Direct Ownership Interest Feb 1, 2005 55%
5% Or Greater Direct Ownership Interest Apr 1, 2017 55%
John R Myers Individual Corporate DirectorBoard Member Sep 30, 2022
Lynne Henricks Individual Corporate DirectorBoard Member Sep 30, 2022
Mark Westen Individual Corporate DirectorBoard Member Oct 1, 2023
Lori Peck Individual Corporate DirectorVP - Finance Sep 30, 2015
W-2 Managing EmployeeVP-Finance Sep 30, 2015
Operational/Managerial ControlVP-Finance Sep 30, 2015
W-2 Managing EmployeeVP - Finance Sep 30, 2015
Operational/Managerial ControlVP - Finance Sep 30, 2015
Roshini Samuel Individual Corporate DirectorBoard Member Sep 30, 2021
Sherry Bunten Individual W-2 Managing Employee Jan 1, 2022
Tyler Hack Individual Corporate DirectorVP - Revenue Cycle Feb 26, 2024
W-2 Managing EmployeeVP - Revenue Cycle Feb 26, 2024
Operational/Managerial ControlVP - Revenue Cycle Feb 26, 2024
W-2 Managing EmployeeSVP and Chief Financial Offic Feb 26, 2024
Operational/Managerial ControlSVP and Chief Financial Officer Feb 26, 2024
Michael B Winter Individual Corporate DirectorChairman Jan 1, 2001
Corporate DirectorChairman Jan 1, 2014
Matthew F Heywood Individual Corporate DirectorPresident & Chief Executive Officer Jul 1, 2013
W-2 Managing EmployeeCeo Jul 31, 2013
Operational/Managerial ControlCeo Jul 31, 2013
Corporate DirectorPresident/Ceo of Aspirus, Inc Jul 1, 2013

Owners & managing parties with NPI records 2

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

Facilities with the same owner 79

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

View all 79

Practitioners & affiliated clinicians

Practitioners 88

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 88

Affiliated clinicians 197

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

View all 197

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1821151366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29980 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606731299",
            "telephone_number": "715-847-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 E 5TH AVE",
            "city": "ANTIGO",
            "state": "WI",
            "postal_code": "544092710",
            "telephone_number": "715-623-2351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANGLADE HOSPITAL - HOTEL DIEU OF ST JOSEPH OF ANTIGO WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "YANG",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "SVP & CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "715-847-2526"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WI",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Aspirus Antigo Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Aspirus Antigo Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Antigo, WI

Sources for this page

Verify at the official NPI Registry.