NPIMap

Organization Active NPI

Thedacare, Incorporated

  • Community Based Hospice Care Agency
  • Appleton, WI
National Provider Identifier
1881787380
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
THEDACARE, INCORPORATED
Practice address
3000 E College Ave
Suite a
Appleton, WI 54915
Phone
(920) 969-0919
Fax
(920) 730-3433
NPI assigned
Oct 2, 2006
Last updated
Jan 2, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 1504 WI
Community Based Hospice Care Agency 251G00000X WI Primary

Addresses

Primary practice location

3000 E College Ave
Suite a
Appleton, WI 54915

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 969-0919

Other identifiers 1

IdentifierTypeStateIssuer
43187600MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051012000684 WI Part A Provider - Hospice 1759294887 Practice locations: Appleton, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881787380. Details of each certification follow.

Hospice certification: CCN 521504

Legal name
THEDACARE, INCORPORATED
Doing business as
THEDACARE AT HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Jul 2, 1985
Last certification
Mar 7, 2020
Ownership / control type
Non-Profit - Other
Organization structure
CorporationNon-profit
Incorporated
Jan 22, 1985 in WI
Enrollment address
3000 E College Ave
# A
Appleton, WI 54915-3251

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Thedacare at HomeCCN 521504 · All quality measures
Ownership
Non-Profit
Certified
Jul 2, 1985
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Thedcare Physicians Iol20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Ownership & related parties

All disclosed owners & managing parties 15

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
Megan Rennie Individual W-2 Managing EmployeeAdministrator Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing Employee Jun 1, 2023
Laurie a Carter Individual Corporate DirectorBoard Member Feb 11, 2022
Mary W Goggans Individual Corporate DirectorBoard Member Feb 11, 2022
Alan Loux Individual Corporate DirectorBoard Member Jan 1, 2023
Timothy J Jessick Individual Corporate DirectorMedical Director Apr 1, 2026
W-2 Managing EmployeeMD; Apr 1, 2026
William Flett Individual Corporate OfficerCfo Oct 31, 2023
W-2 Managing Employee Oct 31, 2023
Imran a Andrabi Individual Corporate OfficerPresident, Board of Trustees Jun 28, 2017
Corporate DirectorCeo Jun 28, 2017
W-2 Managing EmployeeCeo Jun 28, 2017
Chuck Dallas Individual Corporate Director Feb 11, 2021
David W Koeper Individual Corporate Officer Jan 1, 2016
Susan M Pahl Individual W-2 Managing EmployeeCredentialing Specialist Jan 1, 2023
Steven J Price Individual Corporate Director Jan 1, 2023
Kathleen Pigeon Individual W-2 Managing EmployeeCredentialing Specialist Jun 11, 2000
Michael Morse Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 15

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Thedacare Medical Center - Berlin, Inc.Berlin, WI, CCN 521355 Hospital Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 521303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Wild Rose, Inc.Wild Rose, WI, CCN 52Z303 Hospital Operational/Managerial Control Jul 1, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 521346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 52Z346 Hospital Operational/Managerial Control Jan 30, 2011
Thedacare Regional Medical Center-Neenah IncNeenah, WI, CCN 520045 Hospital Operational/Managerial Control Jan 19, 2011
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 520160 Hospital Operational/Managerial Control Nov 22, 2010
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 521334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - Waupaca, IncWaupaca, WI, CCN 52Z334 Hospital Operational/Managerial Control Jun 1, 2006
Thedacare Medical Center - New London, IncNew London, WI, CCN 521326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Medical Center - New London, IncNew London, WI, CCN 52Z326 Hospital Operational/Managerial Control Jan 1, 2000
Thedacare Regional Medical Center - Appleton, IncAppleton, WI, CCN 52T160 Hospital Operational/Managerial Control Jan 1, 2024
Juliette ManorBerlin, WI, CCN 525286 Skilled nursing facility Operational/Managerial Control (100%) Jun 30, 2014
Thedacare Medical Center - Shawano, Inc.Shawano, WI, CCN 528614 Rural health clinic Operational/Managerial Control Jan 19, 2011
Shawano Medical Center IncClintonville, WI, CCN 528608 Rural health clinic Operational/Managerial Control Jan 19, 2011

Owned or controlled facilities with NPI records 30

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

View all 30

Facilities with the same owner 25

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 25

Practitioners & affiliated clinicians

Affiliated clinicians 144

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

View all 144

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1881787380",
    "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": "920-969-0919",
            "fax_number": "920-730-3433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 E COLLEGE AVE",
            "address_2": "SUITE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "54915",
            "telephone_number": "920-969-0919",
            "fax_number": "920-730-3433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE, INCORPORATED",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-02",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "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"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WI",
            "license": "1504",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43187600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.