NPIMap

Organization Active NPI

Children's Hospital of Wisconsin, Inc.

Doing business as Children's Hospital of Wisconsin, Inc. - Fox Valley

  • Children's Hospital
  • Neenah, WI
National Provider Identifier
1881780302
Registry record updated Mar 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Children's HospitalTaxonomy code 282NC2000X
License
1005 Issued in WI
Legal business name
CHILDREN'S HOSPITAL OF WISCONSIN, INC.
Doing business as
Children's Hospital of Wisconsin, Inc. - Fox Valley
Practice address
130 Second St
Neenah, WI 54956
Phone
(920) 969-7900
Fax
(920) 969-7997
NPI assigned
Oct 4, 2006
Last updated
Mar 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2016

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

Authorized official

Name
Mr. Marc Cadieux
Title
Corporate VP and Cfo
Phone
(414) 266-6226

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Children's Hospital 282NC2000X 1005 WI Primary

Addresses

Primary practice location

130 Second St
Neenah, WI 54956

Mailing address

PO Box 1997
Milwaukee, WI 53201-1997
Phone (414) 266-2000

Other identifiers 3

IdentifierTypeStateIssuer
40-4642487MedicaidMI
11023400MedicaidWI
30-4642478MedicaidMI

Other names 1

  • Children's Hospital of Wisconsin, Inc. - Fox Valley Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110927000890 WI Part A Provider - Hospital 4486687399 Practice locations: De Pere, WI; Neenah, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881780302. Details of each certification follow.

Hospital certification: CCN 523302

Legal name
CHILDRENS HOSPITAL OF WISCONSIN INC
Doing business as
CHILDREN'S HOSPITAL OF WISCONSIN-FOX VALLEY
Certification status
Active
Provider type (POS)
Hospital – Children’s
Participating since
Mar 14, 2001
Last certification
Sep 23, 2003
Beds
42
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Mar 20, 1894 in WI
Enrollment address
130 2ND St
Neenah, WI 54956-2883
Other Hospital Practice Location
Hospital subgroups
Children’s

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Childrens Hospital of Wisconsin Fox ValleyCCN 523302 · All quality measures
Type
Childrens
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Children's Hospital of Wiscosnin Inc22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 37

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

NameRoleSinceShare
Kelly Grebe Individual Corporate Director Jan 1, 2021
Rolando Rodriguez Individual Corporate DirectorBoard Member Jan 1, 2018
Phoebe Williams Individual Corporate DirectorBoard Member Jan 1, 2015
Timothy J Martin Individual Corporate Director Jan 1, 2021
Eve Hall Individual Corporate Director Jan 1, 2021
Mark a Cadieux Individual Corporate DirectorCorporate VP & Cfo Oct 16, 2010
W-2 Managing EmployeeCorporate VP & Cfo Jun 22, 2015
James G Simaras Individual Corporate OfficerVP Financial Services Mar 17, 2016
W-2 Managing EmployeeVP Financial Services Mar 17, 2016
Patrick Hammes Individual Corporate Director Jan 1, 2021
Jason Jarzembowski Individual Corporate Director Jan 1, 2021
Todd Adams Individual Corporate Director Jan 1, 2021
Nancy Korom Individual Corporate Officer Jan 1, 2021
Christopher Kaltenbach Individual Corporate DirectorBoard Member Jan 1, 2015
Mark Witt Individual Corporate Director Jan 1, 2021
Thomas Arenberg Individual Corporate DirectorBoard Member Jan 1, 2015
Paul Knoebel Individual Corporate DirectorBoard Member Jan 1, 2015
Jamie Purko Individual Corporate Director Jan 1, 2021
Linda Benfield Individual Corporate Director Jan 1, 2021
Margaret N Troy Individual Corporate OfficerPresident & Ceo Jan 1, 2009
Corporate DirectorPresident & Ceo Jan 1, 2009
W-2 Managing EmployeePresident & Ceo Jan 1, 2009
Thomas Precia Individual Corporate Director Jan 1, 2021
Christina Chang Individual Corporate Director Jan 1, 2022
David Margolis Individual Corporate Director Jan 1, 2021
John Reichert Individual Corporate Director Jan 1, 2021
Kenneth Bockhorst Individual Corporate Director Jan 1, 2021
Monica Ricca Individual Corporate OfficerVP Revenue Cycle Jan 1, 2015
W-2 Managing EmployeeVP Revenue Cycle Jan 1, 2015
Benjamin Blanton Melson Individual Corporate Director Jan 1, 2021
Todd Endres Individual Corporate Director Jan 1, 2021
Keith T Oldham Individual Corporate Director Jan 1, 2021
Dave Werner Individual Corporate Director Jan 1, 2021
Nancy Avila Individual Corporate Director Jan 1, 2021
Craig Duncan Individual W-2 Managing Employee Jan 1, 2021
Michelle Gass Individual Corporate Director Jan 1, 2021
Matthew D'Attilio Individual Corporate Director Jan 1, 2021
Michael Gutzeit Individual Corporate Officer Jan 1, 2021
James Popp Individual Corporate DirectorBoard Member Jan 1, 2015
Tim Gerend Individual Corporate Director Jan 1, 2021
Gail Ostrander Individual Corporate OfficerVP Northeast Region Jan 2, 2018
W-2 Managing EmployeeVP Northeast Region Jan 2, 2018
Joseph Gehrke Individual Corporate DirectorBoard Member Jan 1, 2015

Owners & managing parties with NPI records 3

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

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1881780302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1997",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532011997",
            "telephone_number": "414-266-2000",
            "fax_number": "414-266-6409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 SECOND ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "54956",
            "telephone_number": "920-969-7900",
            "fax_number": "920-969-7997"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHILDREN'S HOSPITAL OF WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "CADIEUX",
        "authorized_official_first_name": "MARC",
        "authorized_official_title_or_position": "CORPORATE VP AND CFO",
        "authorized_official_telephone_number": "414-266-6226",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282NC2000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Children",
            "state": "WI",
            "license": "1005",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40-4642487",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11023400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30-4642478",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Children's Hospital of Wisconsin, Inc. - Fox Valley",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Neenah, WI

Sources for this page

Verify at the official NPI Registry.