NPIMap

Organization Active NPI

Thedacare Medical Center - Berlin, Inc.

  • Critical Access Hospital
  • Wautoma, WI
National Provider Identifier
1992159289
Registry record updated Jan 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1060 Issued in WI
Legal business name
THEDACARE MEDICAL CENTER - BERLIN, INC.
Practice address
N2930 State Road 22
Wautoma, WI 54982-5267
Phone
(920) 361-1313
NPI assigned
Apr 22, 2016
Organization subpart
Yes
Parent organization
THEDACARE MEDICAL CENTER - BERLIN, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 3, 2024

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

Authorized official

Name
William Flett
Title
Cfo
Phone
(920) 454-4013

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 1060 WI Primary

Addresses

Primary practice location

N2930 State Road 22
Wautoma, WI 54982-5267

Mailing address

3 Neenah Ctr
Neenah, WI 54956-3070
Phone (920) 830-5900

Other identifiers 1

IdentifierTypeStateIssuer
521355OtherWIMEDICARE PTAN

Other names 1

  • COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050302000751 WI Part A Provider - Critical Access Hospital 0446151666 Receives reassigned benefits from 50 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Berlin, WI; Ripon, WI; Wautoma, WI

Hospital certification: CCN 521355

Legal name
THEDACARE MEDICAL CENTER - BERLIN, INC.
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2005
Last certification
Feb 4, 2009
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Dec 19, 2010 in WI
Enrollment address
225 Memorial Dr
Berlin, WI 54923-1243

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Thedacare Medical Center - Berlin IncCCN 521355
Overall star rating
3 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
CHN Lifeskills12 organizations share this tax ID, including this one
Part of
CHN Lifeskills

Other organizations with this tax ID 11

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

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Froedtert Thedacare Health, Inc. Organization, Milwaukee, WI Corporation, Non-profit Operational/Managerial Control Jan 1, 2024
Jennifer R Glasheen Individual W-2 Managing EmployeePayer Contracting Jan 1, 2024
Thedacare, Incorporated Organization, Neenah, WI Non-profit Operational/Managerial Control Jun 30, 2014 100%
Craig M Batley Individual Corporate OfficerBoard Member-Secretary Jan 1, 2017
Mark Cockley Individual Corporate DirectorBoard Member Jan 1, 2024
Michele Clark Individual Corporate DirectorBoard Member Jan 1, 2024
Margaret Bostelmann Individual Corporate OfficerBoard Member-Treasurer Apr 17, 2018
Tammy a Bending Individual Corporate DirectorBoard Member-VP Cah Operations Jan 23, 2017
W-2 Managing EmployeeBoard Member-VP Cah Operation Jan 23, 2017
Margaret Posorske Individual Corporate DirectorBoard Member Jan 1, 2024
John M Blazel Individual Corporate OfficerBoard Member-Chair Apr 17, 2018
William Flett Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Jenna E Walker Individual W-2 Managing EmployeeDirector of Legal Services Nov 15, 2011
Imran a Andrabi Individual Corporate OfficerCeo-President Jun 28, 2017
W-2 Managing Employee Jun 28, 2017
Buffy Lynn Detterman Individual Corporate DirectorBoard Member Jan 1, 2024
Jared Abbrederis Individual Corporate DirectorBoard Member Jan 1, 2022
Jayson J Duffy Individual Corporate OfficerBoard Member-Vice Chair Jan 1, 2017
Kirsten E Grove Individual Corporate DirectorBoard Member Jan 1, 2024
Susan M Pahl Individual W-2 Managing EmployeeProvider Enrollment Jun 1, 2015
Steven Taylor Rasmussen Individual Corporate DirectorBoard Member Jan 1, 2024
Kathleen Pigeon Individual W-2 Managing Employee Jun 11, 2020

Owners & managing parties with NPI records 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 8

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

Affiliated clinicians 178

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

View all 178

NPI Registry JSON

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

{
    "created_epoch": "1461283200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704240000000",
    "number": "1992159289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 NEENAH CTR",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549563070",
            "telephone_number": "920-830-5900",
            "fax_number": "920-830-5910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2930 STATE ROAD 22",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549825267",
            "telephone_number": "920-361-1313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDACARE MEDICAL CENTER - BERLIN, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THEDACARE MEDICAL CENTER - BERLIN, INC.",
        "enumeration_date": "2016-04-22",
        "last_updated": "2024-01-03",
        "certification_date": "2024-01-03",
        "status": "A",
        "authorized_official_last_name": "FLETT",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-454-4013"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "1060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "521355",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "COMMUNITY HEALTH NETWORK, INC. AND BERLIN MEMORIAL HOSPITAL",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Wautoma, WI

Sources for this page

Verify at the official NPI Registry.