NPIMap

Organization Active NPI

Thedacare Regional Medical Center-Neenah, Inc.

  • General Acute Care Hospital
  • Oshkosh, WI
National Provider Identifier
1861943409
Registry record updated Jan 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
32 Issued in WI
Legal business name
THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.
Practice address
600 N Westhaven Dr
Oshkosh, WI 54904-6926
Phone
(920) 831-5050
Fax
(920) 735-7596
NPI assigned
Oct 19, 2016
Last updated
Jan 17, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 17, 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
General Acute Care Hospital 282N00000X 32 WI Primary

Addresses

Primary practice location

600 N Westhaven Dr
Oshkosh, WI 54904-6926

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
32OtherWILICENSE

Other names 1

  • THEDA CLARK 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
O20081006000715 WI Part A Provider - Hospital 8921090846 4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Menasha, WI; Neenah, WI; Oshkosh, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1861943409. Details of each certification follow.

Hospital certification: CCN 520045

Legal name
THEDACARE REGIONAL MEDICAL CENTER-NEENAH INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Feb 12, 2010
Beds
182
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 23, 1909 in WI
Enrollment address
130 2ND St
Neenah, WI 54956-2883
Main/Primary Hospital Location
Hospital subgroups
General, Rehabilitation

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Thedacare Regional Med Ctr - NeenahCCN 520045 · 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
Tax ID family
Theda Clark Reg Med CT15 organizations share this tax ID, including this one
Part of
Theda Clark Reg Med CT

Other organizations with this tax ID 14

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

View all 14

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
Froedtert Thedacare Health, Inc. Organization, Milwaukee, WI Corporation, Non-profit Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing EmployeePayer Contracting Jan 1, 2023
Laurie a Carter Individual Corporate DirectorBoard Member Feb 1, 2022
Thedacare, Incorporated Organization, Neenah, WI Corporation, Non-profit Operational/Managerial Control Jan 19, 2011
Mary W Goggans Individual Corporate DirectorBoard Member Feb 1, 2022
Alan Loux Individual Corporate Director Jan 1, 2023
William Flett Individual Corporate DirectorCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Imran a Andrabi Individual Corporate DirectorCeo-President Jun 28, 2017
W-2 Managing EmployeeCeo-President Jun 28, 2017
Chuck Dallas Individual Corporate DirectorBoard Member Feb 11, 2021
David W Koeper Individual Corporate DirectorBoard Member Mar 1, 2022
Susan M Pahl Individual W-2 Managing Employee Jan 1, 2022
Steven J Price Individual Corporate Director Jan 1, 2023
Kathleen Pigeon Individual W-2 Managing EmployeeProvider Enrollment Jun 11, 2020
Michael Morse Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 14

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

View all 14

Practitioners & affiliated clinicians

Affiliated clinicians 901

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

View all 901

NPI Registry JSON

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

{
    "created_epoch": "1476835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705449600000",
    "number": "1861943409",
    "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": "600 N WESTHAVEN DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549046926",
            "telephone_number": "920-831-5050",
            "fax_number": "920-735-7596"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THEDACARE REGIONAL MEDICAL CENTER-NEENAH, INC.",
        "enumeration_date": "2016-10-19",
        "last_updated": "2024-01-17",
        "certification_date": "2024-01-17",
        "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": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WI",
            "license": "32",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "32",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THEDA CLARK MEDICAL CENTER INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "THEDA CLARK MEDICAL CENTER INC.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Oshkosh, WI

Sources for this page

Verify at the official NPI Registry.