NPIMap

Organization Active NPI

Thedacare Regional Medical Center - Appleton, Inc.

  • General Acute Care Hospital
  • Appleton, WI
National Provider Identifier
1902832306
Registry record updated Jan 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
169 Issued in WI
Legal business name
THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC.
Practice address
1818 N Meade St
Appleton, WI 54911-3454
Phone
(920) 731-4101
NPI assigned
Jun 25, 2006
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
Mr. William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 169 WI Primary

Addresses

Primary practice location

1818 N Meade St
Appleton, WI 54911-3454

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other identifiers 1

IdentifierTypeStateIssuer
110019000MedicaidWI

Other names 1

  • Appleton Medical Center,Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040304000064 WI Part B Supplier - Clinic/Group Practice 2163319039 Receives reassigned benefits from 33 practitioners
2 other NPIs on this enrollment
Practice locations: Appleton, WI; Fond Du Lac, WI; Oshkosh, WI
O20101215000214 WI Part A Provider - Hospital 2163319039 6 other NPIs on this enrollment
Practice locations: Appleton, WI; Fond Du Lac, WI; Oshkosh, WI

Hospital certification: CCN 520160

Legal name
THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Mar 13, 2013
Beds
160
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Feb 20, 1958 in WI
Enrollment address
1818 N Meade St
Appleton, WI 54911-3454
Main/Primary Hospital Location
Hospital subgroups
General

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Thedacare Regional Medical Center - Appleton IncCCN 520160
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

2280 Harrison Ave
Ste K
Eureka, CA 95501
Phone (707) 443-9371

Ownership & related parties

All disclosed owners & managing parties 14

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
Jennifer R Glasheen Individual W-2 Managing EmployeeDirector, Payer Contracting Jan 1, 2023
Laurie a Carter Individual Corporate DirectorBoard Member Feb 1, 2022
Thedacare, Incorporated Organization, Neenah, WI Corporation, Non-profit, Chain home office Operational/Managerial Control Nov 22, 2010
Mary W Goggans Individual Corporate DirectorBoard Member Feb 1, 2022
Alan Loux Individual Corporate DirectorBoard Member Jan 1, 2023
William Flett Individual Corporate DirectorCfo Oct 31, 2023
W-2 Managing Employee Oct 31, 2023
Imran a Andrabi Individual Corporate Director Jun 28, 2017
Chuck Dallas Individual Corporate DirectorBoard Member Feb 11, 2021
David W Koeper Individual Corporate DirectorBoard Member Jan 1, 2023
Susan M Pahl Individual W-2 Managing EmployeeDelegated Official Jan 1, 2023
Steven J Price Individual Corporate DirectorBoard Member Jan 1, 2024
Kathleen Pigeon Individual W-2 Managing EmployeeDelegated Official Jun 11, 2000
Michael Morse Individual Corporate DirectorBoard Member Jan 1, 2024

Owners & managing parties with NPI records 14

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

View all 14

Facilities with the same owner 26

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

View all 26

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

Affiliated clinicians 827

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

View all 827

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1902832306",
    "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": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113454",
            "telephone_number": "920-731-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE REGIONAL MEDICAL CENTER - APPLETON, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-25",
        "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",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "WI",
            "license": "169",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110019000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Appleton Medical Center,Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Appleton Medical Center,Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.