NPIMap

Organization Active NPI

Capitol Lakes Inc.

  • Skilled Nursing Facility
  • Madison, WI
National Provider Identifier
1902877632
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CAPITOL LAKES INC.
Doing business as
Capitol Lakes Inc.
Practice address
333 W Main St
Madison, WI 53703-2777
Phone
(608) 283-2141
NPI assigned
Jan 31, 2006
Last updated
Dec 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Authorized official

Name
Tim Conroy
Title
Executive Director
Phone
(608) 621-8062

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

333 W Main St
Madison, WI 53703-2777

Mailing address

333 W Main St
Madison, WI 53703-2777
Phone (608) 283-2141

Other identifiers 1

IdentifierTypeStateIssuer
20124200MedicaidWI

Other names 1

  • Capitol Lakes Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080129000167 WI Part A Provider - Skilled Nursing Facility 5193807295 Practice locations: Madison, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902877632. Details of each certification follow.

Skilled nursing facility certification: CCN 525305

Legal name
CAPITOL LAKES INC.
Doing business as
CAPITOL LAKES HEALTH CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 4, 1979
Last certification
Nov 6, 2024
Beds
49
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 26, 1982 in WI
Enrollment address
334 W Doty St
Madison, WI 53703-3107
Nursing home name
CAPITOL LAKES HEALTH CENTER
Affiliated entity
PACIFIC RETIREMENT SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Capitol Lakes Health CenterCCN 525305 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 4, 1979
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4926.1 residents per day on average
Chain
Pacific Retirement Services10 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0876255Capitol Lakes Health Center334 W Doty St, Madison, WI 53703Certificate of waiverSep 14, 2027

National Provider Directory

National Provider Directory

Locations

334 W Doty St
Madison, WI 53703
Phone (608) 283-2000

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Sue Center Individual Corporate OfficerBoard Chair Jun 21, 2017
KBC Bank NV Organization, New York, NY Corporation, Financial institution, For-profit 5% Or Greater Security Interest Jan 1, 2022 55%
Sally J Drew Individual Corporate DirectorSecretary and Treasurer Oct 10, 2016
Stephen Johannsen Individual Corporate OfficerBoard Member Jan 16, 2019
Clay Norrbom Individual Corporate OfficerBoard Vice Chair Nov 17, 2017
Lapis Municipal Opportunities Fund III LP Organization, Larkspur, CA Corporation, Financial institution, For-profit 5% Or Greater Security Interest Jan 1, 2022 45%
Timothy J Conroy Individual W-2 Managing EmployeeExecutive Director Mar 23, 2009
Harry Peterson Individual Corporate OfficerBoard Member Jun 21, 2017
Pacific Retirement Services Inc Organization, Medford, OR Corporation, Management services company, Non-profit Operational/Managerial Control Apr 1, 2008 100%
Richard Bishop Individual Corporate OfficerBoard Member Oct 1, 2021
Eric Sholty Individual Corporate OfficerCeo May 27, 2018

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1138665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1902877632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 W MAIN ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537032777",
            "telephone_number": "608-283-2141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 W MAIN ST",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537032777",
            "telephone_number": "608-283-2141"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAPITOL LAKES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-31",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "CONROY",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "608-621-8062"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20124200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Capitol Lakes Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.