Beaver Dam Community Hospitals Inc
Organization Active NPI Community Based Hospice Care Agency · Beaver Dam, WI
NPI 1962463760 · NPPES record last updated Jul 18, 2025
Key facts
- NPI
- 1962463760
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- License
- 1518 (WI)
- Legal business name
- BEAVER DAM COMMUNITY HOSPITALS INC
- Practice address
- 707 S University Ave
Beaver Dam, WI 53916-3027 - Phone
- (920) 887-4050
- NPI assigned
- Mar 31, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MARSHFIELD CLINIC HEALTH SYSTEM INC
Authorized official
- Name
- Jolyn Munson
- Title
- VP Revenue Cycle Operations
- Phone
- (605) 328-6585
Parent organization (reported in NPPES) 1
Owners & managing parties with NPI records 4
-
Brian Hoerneman, MD
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 8
Member of 1
Facilities with the same owner 41
Practitioners 64
-
Omar Abdelmegid, MD
-
Mesfin Taye Abera, M.D.
-
Shawn Douglas Antle, M.D.
-
Priya Asija, MD
-
Meghan Asleson, CRNA
-
Michelle J Bartzen, PA-C
-
Chloe Bille, MSPAS, PA-C
-
Megan G Bisson, CRNA
-
David Brad Bogard, CRNA
-
Shelby Ann Brandsma, LCSW
-
Heather B. Breen, M.D.
-
Aaron M Carpiaux, MD
-
Kristin Ann Cuff, NP
-
Kyle M Dennison, DPM
-
Christina Friedl, MD
-
Ruth Marie Grams, APNP,
-
Lonna L Grosskopf, CRNA
-
Jacob Kraemer, MD
-
Kirsten Carly Krohn, M.D.
Affiliated clinicians 6
-
Marc Bernard Gladden II, D.O.
-
Erin R Lambert, DO
-
Amy J Muchow, MD
Medicare Care Compare: Hospice
- Listed as
- Hillside Hospice
- Ownership
- Non-Profit
- Certified
- Apr 13, 1988
- Medicare certification status
- Active
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Hospice certification: CCN 521518
- Legal name
- BEAVER DAM COMMUNITY HOSPITALS INC.
- Doing business as
- HILLSIDE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 13, 1988
- Last certification
- Feb 9, 2022
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation · Non-profit
- Incorporated
- Feb 28, 1972 in WI
- Enrollment address
- 707 S University Ave
Beaver Dam, WI 53916-3027
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Brian D Hoerneman |
Corporate Officer |
Apr 4, 2023 | |
| Corporate Director |
Sep 1, 2023 | ||
| Tony Lee Morrison |
W-2 Managing Employee |
Jan 1, 2025 | |
| John F Baltus |
Corporate Officer |
Sep 8, 2023 | |
| Corporate Director |
Feb 4, 2016 | ||
| Lindsey a Buswell Cleary |
W-2 Managing Employee |
Dec 1, 2023 | |
| Jolyn Joy Munson |
W-2 Managing Employee |
Jan 1, 2025 | |
| Dennis H Smith |
Corporate Director | Jan 14, 2025 | |
| Jeffrey Douglas Poppen |
Corporate Officer |
Jun 12, 2025 | |
| W-2 Managing Employee |
Jun 12, 2025 | ||
| Edward G Fernandez |
Corporate Officer |
Jan 1, 2025 | |
| Corporate Director |
Sep 8, 2023 | ||
| Kelly Danner |
W-2 Managing Employee |
Jul 11, 2025 | |
| Operational/Managerial Control |
Jul 11, 2025 | ||
| MCHS Hospitals Inc |
5% Or Greater Direct Ownership Interest | May 1, 2019 | 100% |
| Samantha L Klebe |
Corporate Director |
Sep 8, 2023 | |
| W-2 Managing Employee |
Jan 1, 2025 | ||
| Linda Laverne Procci |
Corporate Director | Feb 1, 2025 | |
| Sanford |
5% Or Greater Indirect Ownership Interest | Jan 1, 2025 | |
| Everett W Newcomb |
Corporate Director |
Sep 13, 2024 | |
| Marshfield Clinic Health System Inc |
5% Or Greater Indirect Ownership Interest | May 1, 2019 | 100% |
| Douglas Mathison |
Corporate Director |
Dec 15, 2020 | |
| Nicholas Wayne Olson |
W-2 Managing Employee |
Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070214000067 | WI | Part a Provider - Hospice | 2567370539 | Practice locations: Beaver Dam, WI |
National Provider Directory
- Tax ID family
- Beaver Dam Comm Hosp Inc
- Part of
- Marshfield Clinic Health System Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 1518 | WI | Yes |
Addresses
Primary practice location
707 S University Ave
Beaver Dam, WI 53916-3027
Mailing address
1000 N Oak Ave
Provider Enrollment Services - SHP FL 2
Marshfield, WI 54449-5703
Other names
- Hillside Hospice
Other providers in Beaver Dam, WI
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- Beaver Dam Community Hospitals, Inc
- Beaver Dam Dental LLC
All providers in Beaver Dam, WI · Community Based Hospice Care Agency 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 18, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.