NPIMap

Organization Active NPI

Waupun Memorial Hospital

Doing business as SSM Health Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Beaver Dam, WI
National Provider Identifier
1881672004
Registry record updated Apr 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WAUPUN MEMORIAL HOSPITAL
Doing business as
SSM Health Dialysis Center
Practice address
110 Monroe St
Beaver Dam, WI 53916-2437
Phone
(920) 887-3376
Fax
(920) 887-3532
NPI assigned
Jan 6, 2006
Last updated
Apr 20, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WAUPUN MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 2022

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

Authorized official

Name
Troy Walker
Title
Director of Finance
Phone
(608) 356-1423

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

110 Monroe St
Beaver Dam, WI 53916-2437

Mailing address

PO Box 1283
Fond Du Lac, WI 54936-1283
Phone (920) 926-4472

Other names 1

  • SSM Health Dialysis Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110808000471 WI Part A Provider - End-Stage Renal Disease Facility (ESRD) 7618886565 Practice locations: Beaver Dam, WI

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
Tax ID family
Family Health St2 organizations share this tax ID, including this one
Part of
Family Health St

Other organizations with this tax ID 1

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

Member of 2

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

Locations

110 Monroe St
Beaver Dam, WI 53916
Phone (920) 887-3376

NPI Registry JSON

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

{
    "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, WI

Sources for this page

  • 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.