NPIMap

Gundersen Clinic, LTD.

Organization Active NPI Clinic/Center · Prairie Du Chien, WI

NPI 1972554590 · NPPES record last updated Aug 6, 2021

Key facts

NPI
1972554590
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
GUNDERSEN CLINIC, LTD.
Practice address
610 E Taylor St
Prairie Du Chien, WI 53821-2109
Phone
(608) 782-7300
NPI assigned
May 16, 2006
Organization subpart
Yes
Parent organization (as reported)
GUNDERSEN CLINIC LTD

Authorized official

Name
Kari B Adank
Title
Cco
Phone
(608) 775-8025

Other NPIs on the same Medicare enrollment 19

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

Corporate family (same tax ID) 12

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

Practitioners 29

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

View all 29

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031106000139 WI Part B Supplier - Clinic/Group Practice 9638082779 Receives reassigned benefits from 1,052 practitioners
19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
O20100930050888 WI DME Supplier - Multi-Specialty - Physician
DME Supplier - Physician - Family Practice		 9638082779 Practice locations: Prairie Du Chien, WI

National Provider Directory

Tax ID family
La Liberte-Gundersen VI (52 organizations share this tax ID)
Part of
La Liberte-Gundersen VI

Locations

1836 South Ave
Ste 1
La Crosse, WI 54601

124 N Court St
Sparta, WI 54656
Phone (608) 269-1588

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Yes
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

610 E Taylor St
Prairie Du Chien, WI 53821-2109

Mailing address

1836 South Ave
La Crosse, WI 54601-5429
Phone (608) 782-7300

Other names

  • GL Prairie Du Chien Clinic Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 6, 2021.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628208000000",
    "number": "1972554590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1836 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015429",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 E TAYLOR ST",
            "city": "PRAIRIE DU CHIEN",
            "state": "WI",
            "postal_code": "538212109",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN CLINIC, LTD.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN CLINIC LTD",
        "enumeration_date": "2006-05-16",
        "last_updated": "2021-08-06",
        "certification_date": "2021-08-06",
        "status": "A",
        "authorized_official_last_name": "ADANK",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "CCO",
        "authorized_official_telephone_number": "608-775-8025"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GL Prairie Du Chien Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Prairie Du Chien, WI

All providers in Prairie Du Chien, WI · Clinic/Center in Wisconsin

Sources for this page

Verify at the official NPI Registry.