NPIMap

Organization Active NPI

Gundersen Lutheran Medical Center, Inc.

  • Rehabilitation Hospital Unit
  • La Crosse, WI
National Provider Identifier
1972675155
Registry record updated Mar 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
GUNDERSEN LUTHERAN MEDICAL CENTER, INC.
Practice address
1910 South Ave
La Crosse, WI 54601-5467
Phone
(608) 782-7300
NPI assigned
Nov 14, 2006
Last updated
Mar 25, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
GUNDERSEN LUTHERAN MEDICAL CENTER, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 25, 2022

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X Primary

Addresses

Primary practice location

1910 South Ave
La Crosse, WI 54601-5467

Mailing address

1910 South Ave
La Crosse, WI 54601-5467
Phone (608) 782-7300

Other identifiers 3

IdentifierTypeStateIssuer
11012900MedicaidWI
0699017MedicaidIA
765347600MedicaidMN

Other names 1

  • GL Rehab Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000728 WI Part A Provider - Hospital 2163331414 Practice locations: La Crosse, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972675155. Details of each certification follow.

Hospital certification: CCN 52T087

Legal name
GUNDERSEN LUTHERAN MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Incorporated
Oct 28, 1899 in WI
Enrollment address
1910 South Ave
La Crosse, WI 54601-5467
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Gundersen Lutheran Medical Center IncCCN 52T087 · All quality measures
Ownership
Non-profit
Certified
May 1, 1984

National Provider Directory

National Provider Directory
Tax ID family
Valley View Nursing Home27 organizations share this tax ID, including this one
Part of
Valley View Nursing Home

Other organizations with this tax ID 26

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

View all 26

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Andrea Hauser Individual Corporate Director Nov 30, 2022
Scott Rathgaber Individual Corporate DirectorBoard of Trustee Jan 1, 2016
Bryan Erdmann Individual Corporate Director Nov 30, 2022
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Nov 30, 2022 100%
Operational/Managerial Control Nov 30, 2022 100%
Lindsay Boehm Individual W-2 Managing EmployeeFinancial Systems Analyst Feb 1, 2022
Todd J Kowalski Individual Corporate Director Nov 30, 2022
Heather Schimmers Individual Corporate Director Nov 30, 2022
Gundersen Lutheran Health System Inc Organization, La Crosse, WI Non-profit 5% Or Greater Direct Ownership Interest Jun 10, 1996 100%
Jennifer E Kleven Individual Corporate DirectorBoard Member Jan 1, 2023
Kari B Adank Individual Corporate OfficerChief Compliance Officer Feb 6, 2018
W-2 Managing Employee Oct 25, 2010

Owners & managing parties with NPI records 3

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

Facilities with the same owner 49

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

View all 49

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1648166400000",
    "number": "1972675155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015467",
            "telephone_number": "608-782-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 SOUTH AVE",
            "city": "LA CROSSE",
            "state": "WI",
            "postal_code": "546015467",
            "telephone_number": "608-782-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUNDERSEN LUTHERAN MEDICAL CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GUNDERSEN LUTHERAN MEDICAL CENTER, INC",
        "enumeration_date": "2006-11-14",
        "last_updated": "2022-03-25",
        "certification_date": "2022-03-25",
        "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": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11012900",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0699017",
            "state": "IA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "765347600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GL Rehab",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in La Crosse, WI

Sources for this page

Verify at the official NPI Registry.