NPIMap

Organization Active NPI

American Baptist Homes of the Midwest

Doing business as Tudor Oaks Retirement

  • Skilled Nursing Facility
  • Muskego, WI
National Provider Identifier
1932197654
Registry record updated May 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Doing business as
Tudor Oaks Retirement
Practice address
S77W12929 McShane Dr
Muskego, WI 53150-4039
Phone
(414) 529-0100
Fax
(414) 529-0537
NPI assigned
Oct 6, 2005
Last updated
May 23, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 2019

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

Authorized official

Name
Christina R Kotz
Title
Director of Resident Receivables
Phone
(402) 639-3008

Specialties & licenses 1

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

Addresses

Primary practice location

S77W12929 McShane Dr
Muskego, WI 53150-4039

Mailing address

S77W12929 McShane Dr
Muskego, WI 53150-4039
Phone (414) 529-0100

Other identifiers 1

IdentifierTypeStateIssuer
20113200MedicaidWI

Other names 1

  • Tudor Oaks Retirement Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070604000412 WI Part A Provider - Skilled Nursing Facility 8426966953 Practice locations: Muskego, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1932197654. Details of each certification follow.

Skilled nursing facility certification: CCN 525279

Legal name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Doing business as
TUDOR OAKS RETIREMENT COMMUNITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1977
Last certification
Mar 6, 2024
Beds
50
Ownership / control type
Church Related
Multi-facility organization
AMERICAN BAPTIST HOMES OF THE MIDWEST
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1982 in MN
Enrollment address
S77W12929 McShane Dr
Muskego, WI 53150-4052
Nursing home name
TUDOR OAKS HEALTH CENTER
Affiliated entity
AMERICAN BAPTIST HOMES OF THE MIDWEST

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: Nursing home

Medicare Care Compare
Listed as
Tudor Oaks Health CenterCCN 525279 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jan 1, 1977
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5044.8 residents per day on average
Chain
American Baptist Homes of the Midwest6 facilities in the chain
Penalties (3 years)
2Fines totaling $180,810

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Tudor Oaks Health Cente14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

14850 Scenic Heights Rd
Ste 125
Eden Prairie, MN 55344

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Ashley Elizabeth Ford Individual Corporate DirectorBoard Member Aug 1, 2019
Ruth Ann Neiman Individual Corporate Director Jan 1, 2021
Christina Kotz Individual W-2 Managing EmployeeDirector of Resident Receivables Aug 1, 2019
Steven C Vanostram Individual Corporate DirectorBoard Member Jan 1, 2014
Bruce K Van Der Beek Individual Corporate Director Jan 1, 2021
James Lee Johnson Individual Corporate DirectorBoard Member Aug 1, 2019
Roger Allan Davidson Individual Corporate DirectorBoard Member Aug 1, 2019
Marshall Peters Individual Corporate DirectorBoard Member Jan 1, 2014
Anilisa McDonald Individual W-2 Managing EmployeeAd; Nov 4, 2019
Ryan Allen Individual Corporate DirectorBoard Member Jan 1, 2014
Anne S Wagoner Ford Individual Corporate Director Aug 1, 2019
Dorothy Johnson Individual Corporate Director Jan 1, 2021
Bruce Randolph Whitaker Individual Corporate DirectorBoard Member Jan 1, 2014
Stephanie Nicole Vaughn-Gray Individual Corporate DirectorBoard Member Aug 1, 2019
Steven J Kim Individual Contracted Managing EmployeeMD; Jan 1, 2024
George Edward Killian Individual Corporate Director Aug 1, 2019
Phillip Hanson Individual Corporate DirectorBoard Member Jan 1, 2014
Lars P Johnson Individual Corporate OfficerCfo Jun 5, 2023
Andrea Blatnik Individual Corporate OfficerVP Fof Human Services Jan 1, 2014
W-2 Managing Employee Jan 1, 2021

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Maple Crest Care CenterOmaha, NE, CCN 285149 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2010
Elm Crest Retirement CommunityHarlan, IA, CCN 165372 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 3, 1967

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1558569600000",
    "number": "1932197654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "S77W12929 MCSHANE DR",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531504039",
            "telephone_number": "414-529-0100",
            "fax_number": "414-529-0537"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "S77W12929 MCSHANE DR",
            "city": "MUSKEGO",
            "state": "WI",
            "postal_code": "531504039",
            "telephone_number": "414-529-0100",
            "fax_number": "414-529-0537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN BAPTIST HOMES OF THE MIDWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2019-05-23",
        "status": "A",
        "authorized_official_last_name": "KOTZ",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF RESIDENT RECEIVABLES",
        "authorized_official_telephone_number": "402-639-3008"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20113200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tudor Oaks Retirement",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tudor Oaks Retirement",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Muskego, WI

Sources for this page

Verify at the official NPI Registry.