NPIMap

Organization Active NPI

St. Clare Memorial Hospital, Inc

Doing business as HSHS SCO Regional Surgery Center Marinette

  • Surgery Physician
  • Marinette, WI
National Provider Identifier
1962861294
Registry record updated Dec 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
ST. CLARE MEMORIAL HOSPITAL, INC
Doing business as
HSHS SCO Regional Surgery Center Marinette
Practice address
1409 Cleveland Ave
Marinette, WI 54143-3918
Phone
(920) 965-7411
NPI assigned
Feb 15, 2016
Last updated
Dec 23, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
ST. CLARE MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 23, 2021

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

Authorized official

Name
Daniel Degroot
Title
Coo
Phone
(920) 846-4581

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU Primary

Addresses

Primary practice location

1409 Cleveland Ave
Marinette, WI 54143-3918

Mailing address

853 S Main St
Oconto Falls, WI 54154-1241
Phone (920) 965-7411

Other names 1

  • HSHS SCO Regional Surgery Center Marinette Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address community_memorial_hospital_transitions_of_care2201223@ewd.direct.hshs.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041023000037 WI Part B Supplier - Clinic/Group Practice 0446211395 Receives reassigned benefits from 239 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Green Bay, WI; Suring, WI; Sturgeon Bay, WI; Oconto Falls, WI; Mountain, WI; Marinette, WI; Lena, WI; Gillett, WI

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Tax ID family
St Clare Memorial Hospital16 organizations share this tax ID, including this one
Part of
St Clare Memorial Hospital

Other organizations with this tax ID 15

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

View all 15

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1640217600000",
    "number": "1962861294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "853 S MAIN ST",
            "city": "OCONTO FALLS",
            "state": "WI",
            "postal_code": "541541241",
            "telephone_number": "920-965-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 CLEVELAND AVE",
            "city": "MARINETTE",
            "state": "WI",
            "postal_code": "541433918",
            "telephone_number": "920-965-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. CLARE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. CLARE MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2016-02-15",
        "last_updated": "2021-12-23",
        "certification_date": "2021-12-23",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "920-846-4581"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "community_memorial_hospital_transitions_of_care2201223@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "1409 Cleveland Ave",
            "city": "Marinette",
            "state": "WI",
            "country_code": "US",
            "postal_code": "541433918",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "HSHS SCO Regional Surgery Center Marinette",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "HSHS SCO Regional Surgery Center Marinette",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marinette, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.