NPIMap

Organization Active NPI

Prairie Ridge Health, Inc.

  • Critical Access Hospital
  • Columbus, WI
National Provider Identifier
1841376183
Registry record updated Nov 6, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
278-800 Issued in WI
Legal business name
PRAIRIE RIDGE HEALTH, INC.
Practice address
1515 Park Ave
Columbus, WI 53925-2402
Phone
(920) 623-2200
Fax
(920) 623-1441
NPI assigned
Oct 30, 2006
Last updated
Nov 6, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2019

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

Authorized official

Name
Mr. John Russell
Title
President & Ceo
Phone
(920) 623-1368

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 278-800 WI Primary

Addresses

Primary practice location

1515 Park Ave
Columbus, WI 53925-2402

Mailing address

1515 Park Ave
Columbus, WI 53925-2402
Phone (920) 623-2200

Other identifiers 4

IdentifierTypeStateIssuer
11012800MedicaidWI
1009297OtherWIPHYSICIANS PLUS INSURANCE
11012810MedicaidWI
000093OtherWIDEAN CARE

Other names 1

  • Columbus Community Health, 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
O20120307000538 WI Part A Provider - Critical Access Hospital 6800791484 Receives reassigned benefits from 163 practitioners
2 other NPIs on this enrollment
Practice locations: Columbus, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841376183. Details of each certification follow.

Hospital certification: CCN 521338

Legal name
PRAIRIE RIDGE HEALTH INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jul 1, 2004
Last certification
Jan 13, 2016
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Aug 25, 1970 in WI
Enrollment address
1515 Park Ave
Columbus, WI 53925-1618
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).

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
Columbus Community HospitalCCN 521338 · All quality measures
Overall star rating
4 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Prairie Ridge Health Inc7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Jennifer J Homman Individual Corporate DirectorBoard Vice Chair Jan 21, 2013
Leslie Alzuhn-Hansen Individual Corporate DirectorDirector Jan 1, 2024
Randall G Bobholz Individual Corporate DirectorBoard Treasurer Jan 20, 2014
John Russell Individual Corporate DirectorDirector Dec 22, 2011
W-2 Managing EmployeeDirector Dec 22, 2011
Joann Evans Individual Corporate DirectorBoard Secretary Jan 21, 2013
Andrea Link Individual Corporate DirectorDirector Dec 7, 2021
W-2 Managing EmployeeDirector Dec 7, 2021
Peter Simon Individual Corporate Director Dec 7, 2021
Melissa S Mangan Individual Corporate OfficerVice President of Finance, Cfo Sep 23, 2019
W-2 Managing Employee Mar 25, 2013
Kyle Nondorf Individual Corporate DirectorDirector Jan 1, 2024
Ann M Roundy Individual W-2 Managing EmployeeVP of Employee Services Dec 22, 2011
Matthew Kinsella Individual Corporate DirectorDirector Jan 1, 2024
Jamie E Hendrix Individual W-2 Managing EmployeeVP Patient Care Services Dec 22, 2011
Julie Saniter Individual Corporate DirectorDirector Jan 1, 2024
Gary J Galvin Individual Corporate DirectorChief of Staff Jul 1, 2011

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 164

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 164

Affiliated clinicians 259

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

View all 259

NPI Registry JSON

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

{
    "created_epoch": "1162166400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572998400000",
    "number": "1841376183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200",
            "fax_number": "920-623-1441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 PARK AVE",
            "city": "COLUMBUS",
            "state": "WI",
            "postal_code": "539252402",
            "telephone_number": "920-623-2200",
            "fax_number": "920-623-1441"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE RIDGE HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-30",
        "last_updated": "2019-11-06",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "920-623-1368",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "278-800",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11012800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS PLUS INSURANCE",
            "identifier": "1009297",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11012810",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "000093",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Columbus Community Health, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Columbus, WI

Sources for this page

Verify at the official NPI Registry.