NPIMap

Organization Active NPI

Thedacare Medical Center - Waupaca, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Waupaca, WI
National Provider Identifier
1831131796
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
3031 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - WAUPACA, INC.
Practice address
800 Riverside Dr
Waupaca, WI 54981-1943
Phone
(715) 258-1000
Fax
(715) 258-1626
NPI assigned
Jun 12, 2006
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
Mr. William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 3031 WI Primary

Addresses

Primary practice location

800 Riverside Dr
Waupaca, WI 54981-1943

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other names 1

  • Riverside Medical Center, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150918000931 WI Part A Provider - Critical Access Hospital 3072504216 Receives reassigned benefits from 1 practitioner
Practice locations: Waupaca, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1831131796. Details of each certification follow.

Hospital certification: CCN 52Z334

Legal name
THEDACARE MEDICAL CENTER - WAUPACA, INC
Organization structure
CorporationNon-profit
Incorporated
Oct 5, 1956 in WI
Enrollment address
800 Riverside Dr
Waupaca, WI 54981-1943
Main/Primary Hospital Location

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Froedtert Thedacare Health, Inc. Organization, Milwaukee, WI Corporation, Non-profit Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing Employee Jan 1, 2023
Thedacare, Incorporated Organization, Neenah, WI Corporation, Non-profit Operational/Managerial Control Jun 1, 2006
Lou Ann Mokwa Individual Corporate DirectorBoard Member Apr 26, 2023
Richard Phillipsen Individual Corporate DirectorChair-Board Member Feb 2, 2022
Jeremy Koehler Individual Corporate DirectorBoard Member Feb 2, 2022
Dale Gisi Individual Corporate DirectorBoard Member Feb 2, 2022
Suzanne Udoni Individual Corporate DirectorBoard Member Feb 2, 2022
Tim Neuville Individual Corporate DirectorBoard Member Feb 2, 2022
Eric Hendrickson Individual Corporate DirectorVice Chair-Board Member Feb 2, 2022
William Flett Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Imran a Andrabi Individual Corporate OfficerCeo-President Jun 28, 2017
W-2 Managing Employee Jun 28, 2017
Jacqueline K Anhalt Individual Corporate DirectorBoard Member Feb 2, 2022
Ellen T Wenberg Individual Corporate DirectorBoard Member Jan 1, 2015
Susan M Pahl Individual W-2 Managing EmployeeProvider Enrollment Jun 15, 2015
Kathleen Pigeon Individual W-2 Managing EmployeeProvider Enrollment Jun 11, 2020

Owners & managing parties with NPI records 13

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

View all 13

Facilities with the same owner 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1831131796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811943",
            "telephone_number": "715-258-1000",
            "fax_number": "715-258-1626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - WAUPACA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WI",
            "license": "3031",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Medical Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Riverside Medical Center, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Waupaca, WI

Sources for this page

Verify at the official NPI Registry.