Stoughton Hospital Association
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Stoughton, WI
NPI 1891869079 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1891869079
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- Legal business name
- STOUGHTON HOSPITAL ASSOCIATION
- Practice address
- 900 Ridge St
Stoughton, WI 53589-1864 - Phone
- (608) 873-6611
- NPI assigned
- Nov 20, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- STOUGHTON HOSPITAL ASSOCIATION
Authorized official
- Name
- Mr. Daniel Degroot
- Title
- President
- Phone
- (608) 873-2250
Owners & managing parties with NPI records 7
-
Ashish M Rawal, MD
-
Aaron T. Schwaab, M.D.
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 2
Member of 1
Related certifications (CCN) 3
Facilities with the same owner 10
Practitioners 80
-
Robert C Pease, M.D.
-
Geoffrey Tyler Bowman, CRNA
-
Richard Huntsman, M.D.
-
Skylar M Larsen, MD
-
Aaron T. Schwaab, M.D.
-
Ajai Shreevatsa, MD
-
Kelly N Lovejoy, PA-C
-
Alisha Fay Maly, PA
-
Mark Belligan, MPA, PA-C
-
Michael D Berger, CRNA
-
Jimmy Clark Jr., P.A. - C
-
Clark A Collins, PA-C
-
Krista Patricia Crawford, P.A.
-
Abigail Rachael Dahlberg, M.D.
-
Debra Dahlke, CRNA
-
Andrew Fischer Dean, M.D.
-
Tina Marie Degroot, APNP
-
Puneet S Dhillon, M.D.
-
Steven E Diebold, MD
-
Noah Figgins, PA-C
Affiliated clinicians 2
-
Mark W Menet, MD
-
Benjamin D Traun, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Hospital certification: CCN 52Z343
- Legal name
- STOUGHTON HOSPITAL ASSOCIATION
- Doing business as
- STOUGHTON HOSPITAL ASSOCIATION
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 9, 1924 in WI
- Enrollment address
- 900 Ridge St
Stoughton, WI 53589-1864
All disclosed owners & managing parties 15
| Name | Role | Since | Share |
|---|---|---|---|
| Kristian Randall Krentz |
Corporate Director | Nov 25, 2019 | |
| Cynthia McGlynn |
Corporate Director | Nov 27, 2023 | |
| Aaron T Schwaab |
Corporate Director | Nov 27, 2017 | |
| Michelle Anne Abey |
Corporate Officer |
Jul 9, 2018 | |
| W-2 Managing Employee | Jul 1, 2015 | ||
| Glenn J Kruser |
Corporate Director | Jan 26, 2022 | |
| Nicholas John Probst |
Corporate Director | Nov 25, 2019 | |
| Timothy P Rusch |
Corporate Director | Nov 23, 2020 | |
| Ashish M Rawal |
Corporate Director | Nov 29, 2021 | |
| Susan Vanderbilt |
Corporate Director | Nov 28, 2022 | |
| Matthew Kinsella |
Corporate Director | Aug 19, 2021 | |
| Steven Peotter |
Corporate Director | Nov 27, 2023 | |
| Dawit Tesfasilassie |
Corporate Director | Aug 17, 2023 | |
| SSM Health Care of Wisconsin Inc |
5% Or Greater Direct Ownership Interest | Feb 6, 2003 | 40% |
| Christopher P Brabant |
Corporate Officer |
Nov 25, 2024 | |
| W-2 Managing Employee |
Nov 25, 2024 | ||
| Donna Olson |
Corporate Director | Nov 26, 2018 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040402001358 | WI | Part B Supplier - Clinic/Group Practice | 7012825706 |
Receives reassigned benefits from 109 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Stoughton, WI; Oregon, WI; McFarland, WI; Cottage Grove, WI |
| O20100208000224 | WI | Part a Provider - Critical Access Hospital | 7012825706 |
Receives reassigned benefits from 3 practitioners Practice locations: Stoughton, WI |
National Provider Directory
- Part of
- Stoughton Hosp
Locations
990 Janesville St
Ste L
Oregon, WI 53575
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | WI | Yes | |
| Critical Access Hospital | 282NC0060X | 3804800 | WI |
Addresses
Primary practice location
900 Ridge St
Stoughton, WI 53589-1864
Mailing address
900 Ridge St
Stoughton, WI 53589-1864
Phone (608) 873-6611
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 11007200 | Medicaid | WI | |
| 11007210 | Medicaid | WI |
Other providers in Stoughton, WI
- Stoughton Family Chiropractic LLC
- Stoughton Family Counseling Services
- Stoughton Hospital Association
- Stoughton Hospital Association
- Stoughton Hospital Association
- Stoughton Meadows Assisted Living Facility
- Stoughton Senior Living, Inc.
- Amy Renee Taebel
- Holly Tangeman
- Renee Annette Taylor
All providers in Stoughton, WI · Medicare Defined Swing Bed Hospital Unit in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.