ST CLARE MEMORIAL HOSPITAL, INC (NPI# 1568552958) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568552958 |
| Entity Type | Organization |
| Organization Name | ST CLARE MEMORIAL HOSPITAL, INC |
| Other Organization Name | ST CLARE MEMORIAL HOSPITAL MOUNTAIN HEALTH CENTER |
| Practice Address |
14353 Hwy 32/64 Mountain WI 54149 |
| Mailing Address |
855 S Main St Oconto Falls WI 54154-1241 |
| Practice Telephone | 7152761600 |
| Practice Fax Number | 7152761800 |
| Mailing Telephone | 9208463444 |
| Mailing Fax Number | 9208460250 |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2014-09-02 |
| Authorized Official Name | DANIEL DEGROOT (CEO) |
| Authorized Official Telephone | 9208463444 |
| Is Organization Subpart | Y |
| Parent Organization Name | ST CLARE MEMORIAL HOSPITAL, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 23967-020 | WI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | GREMBAN NPI | 1316940927 | 01 |
| WI | BOLLENBACH NPI | 1689677213 | 01 |
| WI | 11014110 | 05 | |
| CMH NPI | 1851477913 | 01 |
| Other Name | Type Code |
|---|---|
| St Clare Memorial Hospital Mountain Health Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346371358 | St Clare Memorial Hospital, Inc | Physician Assistant | 200 S. Rosera Street, Lena, WI 54139 | 2007-03-08 |
| 1750412292 | St Clare Memorial Hospital, Inc | Nurse Practitioner | 913 East Main Street, Suring, WI 54174 | 2007-03-08 |
| 1326349135 | St Clare Memorial Hospital, Inc | Medicare Defined Swing Bed Unit | 855 S Main St, Oconto Falls, WI 54154-1241 | 2010-11-10 |
| 1700107844 | St Clare Memorial Hospital, Inc | Physical Therapist | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2010-06-11 |
| 1144541285 | St Clare Memorial Hospital, Inc | Occupational Therapist | 855 S Main St, Oconto Falls, WI 54154-1241 | 2010-06-11 |
| 1780851501 | St Clare Memorial Hospital, Inc | Clinical Medical Laboratory | 855 S Main St, Oconto Falls, WI 54154-1241 | 2008-05-12 |
| 1821216276 | St Clare Memorial Hospital, Inc | Obstetrics & Gynecology | 835 S Main St, Suite 2, Oconto Falls, WI 54154-1282 | 2007-04-23 |
| 1134250905 | St Clare Memorial Hospital, Inc | Nurse Practitioner | 340 N Green Bay Ave, Gillett, WI 54124-9325 | 2007-03-07 |
| 1467583278 | St Clare Memorial Hospital, Inc | Physician Assistant | 103 1st St, Oconto, WI 54153-1117 | 2007-03-07 |
| 1467583096 | St Clare Memorial Hospital, Inc | Family Medicine | 835 S Main St, Suite 1, Oconto Falls, WI 54154-1282 | 2007-03-07 |
| Street Address |
14353 HWY 32/64 |
| City | MOUNTAIN |
| State | WI |
| Zip Code | 54149 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225691017 | St Vincent Hospital-hospital Sisters-third Order of St Francis | Clinic/Center | 14353 Hwy 32/64, Mountain, WI 54149 | 2019-04-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962533455 | Cmh Primary Care Clinic Moutain-physician Dispensary | Family Medicine | 14353 Hwy 32 & 64, Mountain, WI 54149 | 2007-03-08 |
| 1396790770 | Townships of Doty Riverview Mountain Ambulance Service | Ambulance | 14336 Highway 32/64, Mountain, WI 54149 | 2006-05-23 |
| 1407801236 | Cmh Mountain Primary Care Clinic | Non-Pharmacy Dispensing Site | 13435 Weller Rd, Mountain, WI 54149-9482 | 2006-05-23 |
| 1316940927 | Douglas C Gremban | Family Medicine | 14353 State Highway 32 64, Mountain, WI 54149-9656 | 2005-05-27 |
| 1134595051 | Clayton Wesley Keene | Nurse Practitioner | 14353 State Highway 32 64, Mountain, WI 54149-9656 | 2015-08-14 |
| 1144550880 | Community Memorial Hospital | Non-Pharmacy Dispensing Site | 14353 State Highway 32 64, Mountain, WI 54149-9656 | 2009-12-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215537261 | Sylvia Kaye Moore | Home Health Aide | 60 Moore Lane, Mountain, ND 58262-0111 | 2020-10-29 |
| 1578998753 | Borg Pioneer Memorial Home | Custodial Care Facility | 61 Borg Dr, Mountain, ND 58262-6201 | 2013-09-06 |
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962533455 | Cmh Primary Care Clinic Moutain-physician Dispensary | Family Medicine | 14353 Hwy 32 & 64, Mountain, WI 54149 | 2007-03-08 |
| 1316940927 | Douglas C Gremban | Family Medicine | 14353 State Highway 32 64, Mountain, WI 54149-9656 | 2005-05-27 |
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|---|---|---|---|---|
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| 1275159998 | Beam Healthcare, Sc | Family Medicine | 25 W Main St Fl 5, Madison, WI 53703-3399 | 2020-06-18 |
| 1487283503 | Enitza Damaris George | Family Medicine | 1906 Brackett Ave, Eau Claire, WI 54701-5042 | 2020-04-02 |
| 1093341380 | Tia Marie Vaccaro | Family Medicine | 1275 Judd Rd, Oregon, WI 53575-2573 | 2020-03-18 |
| 1134753411 | Proactive Md Sc,p.a. | Family Medicine | Brakebush Health Center, N4993 6th Dr., Westfield, WI 53964 | 2020-02-26 |
| 1790323608 | Solidaritus Health Wisconsin Sc | Family Medicine | 1476 Blazing Star Blvd Ste 4, Altoona, WI 54720-4002 | 2019-12-11 |
| 1255974952 | Integrative Health Center of Central Wisconsin LLC | Family Medicine | 3205 E Washington Ave Ste A, Madison, WI 53704-4332 | 2019-10-25 |
| 1962969220 | Paladina Health, LLC | Family Medicine | Paladina Health Menomonee Falls, N84 W15787 Menomonee Avenue Suite 6, Menomonee Falls, WI 53051 | 2019-02-22 |
| 1942767298 | Paladina Health, LLC | Family Medicine | Paladina Health Sussex Beer Capitol Clinic, W222 N5700 Miller Way, Sussex, WI 53069 | 2019-02-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.