Waupun Memorial Hospital

Primary specialty

End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X

Legal business name

WAUPUN MEMORIAL HOSPITAL

Practice address

110 Monroe St
Beaver Dam, WI 53916-2437

Phone

(920) 887-3376

Fax

(920) 887-3532

NPI assigned

Jan 6, 2006

Organization subpart

Yes

Parent organization

WAUPUN MEMORIAL HOSPITALAs reported in NPPES

Name

Troy Walker

Title

Director of Finance

Phone

(608) 356-1423

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

• Waupun Memorial Hospital

  • Medicare Defined Swing Bed Hospital Unit
  • Waupun, WI
  • NPI 1528046737

  7618886565

  Same PAC ID
• Waupun Memorial Hospital

  • Critical Access Hospital
  • Waupun, WI
  • NPI 1548248644

  7618886565

  Same PAC ID
• Waupun Memorial Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fond Du Lac, WI
  • NPI 1619955838

  7618886565

  Same PAC ID

Organizations this organization is a member of, according to the National Provider Directory.

• Agnesian Healthcare Inc

  • Durable Medical Equipment & Medical Supplies
  • Waupun, WI
  • NPI 1972879641

  Member Of

  NPD member
• SSM Health Care of Wisconsin Inc

  • Certified Registered Nurse Anesthetist
  • Baraboo, WI
  • NPI 1336120401

  Member Of

  NPD member

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Tax ID family

Waupin Memorial Hospita2 organizations share this tax ID, including this one

Part of

Waupin Memorial Hospita

Other organizations with this tax ID 1

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

• Waupun Memorial Hospital

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Fond Du Lac, WI
  • NPI 1619955838
  NPD tax ID

• SSM Health Dialysis Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 20, 2022.

{
    "created_epoch": "1136505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650412800000",
    "number": "1881672004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1283",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549361283",
            "telephone_number": "920-926-4472",
            "fax_number": "920-926-8885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MONROE ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162437",
            "telephone_number": "920-887-3376",
            "fax_number": "920-887-3532"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAUPUN MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WAUPUN MEMORIAL HOSPITAL",
        "enumeration_date": "2006-01-06",
        "last_updated": "2022-04-20",
        "certification_date": "2022-04-20",
        "status": "A",
        "authorized_official_last_name": "WALKER",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "608-356-1423"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN CARE",
            "identifier": "567318",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WI CHRONIC DISEASE PROGRA",
            "identifier": "42059500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42059500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allison Kay Walker, PHARM D
• Kaitlin Nicole Walsh, AU.D.
• Alan James Walton, MD
• Kristopher Wampole, DPT
• Justyce Alexandria Wandersee, APSW
• Kyle Matthew Wayner, PHARMD
• Pamela Webb
• Jody Weber, DPT
• Erin Nicole Wentland, APNP
• Sarah West, SAC-IT

• All providers in Beaver Dam, WI
• End-Stage Renal Disease (ESRD) Treatment Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.