ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC (NPI# 1700043205) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700043205 |
| Entity Type | Organization |
| Organization Name | ASCENSION MEDICAL GROUP-FOX VALLEY WISCONSIN, INC |
| Other Organization Name | ASCENSION MEDICAL GROUP |
| Practice Address |
225 Memorial Dr Berlin WI 54923 |
| Mailing Address |
225 Memorial Dr Berlin WI 54923-1243 |
| Practice Telephone | 9203611313 |
| Mailing Telephone | 9207382000 |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2020-08-05 |
| Authorized Official Name | TIMOTHY L MASEK (VP-FINANCE) |
| Authorized Official Telephone | 4144653000 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM1300X |
Clinic/Center Specialization: Multi-Specialty |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 32752000 | 05 |
| Other Name | Type Code |
|---|---|
| Ascension Medical Group | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437317708 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1160 Service Rd, Kiel, WI 53042 | 2008-05-23 |
| 1679731954 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1128 E Parkway Ave, Oshkosh, WI 54901 | 2008-05-23 |
| 1669639142 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | N9642 County Rd N, Appleton, WI 54915 | 2008-05-21 |
| 1265699748 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Fl 4, Appleton, WI 54915 | 2008-05-21 |
| 1073770558 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1531 S Madison St Ste 580, Appleton, WI 54915 | 2008-05-21 |
| 1639226962 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | N9642 County N, Appleton, WI 54915 | 2007-01-05 |
| 1154478469 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 708 W. Ryan St., Brillion, WI 54110 | 2007-01-05 |
| 1780781096 | Ascension Medical Group-fox Valley Wisconsin, Inc | Durable Medical Equipment & Medical Supplies | 632 Fremont St., Kiel, WI 53042 | 2006-09-20 |
| 1073970984 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1610 Hoover St, New Holstein, WI 53061 | 2016-01-22 |
| 1275963845 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1506 S Oneida St, Appleton, WI 54915 | 2013-11-19 |
| Street Address |
225 MEMORIAL DR |
| City | BERLIN |
| State | WI |
| Zip Code | 54923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962403832 | M Jean Bruce | Family Medicine | 225 Memorial Dr, Suite 1200, Berlin, WI 54923-1243 | 2005-08-02 |
| 1841814472 | Benjamin John Kozloski | Nurse Anesthetist, Certified Registered | 225 Memorial Dr, Berlin, WI 54923-1243 | 2020-05-29 |
| 1003439720 | Courtney Disterhaft | Physical Therapist | 225 Memorial Dr, Berlin, WI 54923-1243 | 2020-05-28 |
| 1457911984 | Nolan S Baker | Speech-Language Pathologist | 225 Memorial Dr, Berlin, WI 54923-1243 | 2019-06-17 |
| 1477043313 | Lina D Ramos | Registered Nurse | 225 Memorial Dr, Berlin, WI 54923 | 2018-05-16 |
| 1891291167 | Northeast Wisconsin Foot and Ankle Assoc., S.c. | Podiatrist | 225 Memorial Dr, Berlin, WI 54923-1243 | 2018-04-04 |
| 1437606373 | Sherry Lynn Reinsbach | Occupational Therapy Assistant | 225 Memorial Dr, Berlin, WI 54923-1243 | 2016-09-08 |
| 1528513272 | Jessica M Braun | Physical Therapy Assistant | 225 Memorial Dr, Berlin, WI 54923-1243 | 2016-08-23 |
| 1326592270 | Brandon Eric Mcmullen | Physical Therapist | 225 Memorial Dr, Berlin, WI 54923-1243 | 2016-08-09 |
| 1508310467 | Marissa Marie Schleis | Physical Therapist | 225 Memorial Dr, Berlin, WI 54923-1243 | 2016-08-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053910067 | Mary Ellen F Pumper | Pharmacist | 861 County Rd F, Berlin, WI 54923 | 2020-10-21 |
| 1962020792 | Brown Wilcox Trustees, Inc. | Home Health | 347 East Huron Street, Berlin, WI 54923 | 2020-07-08 |
| 1083050942 | Veterinary Clinic Berlin/ripon | Veterinarian | W1915 Cty Road F, Berlin, WI 54923 | 2013-05-20 |
| 1114078243 | David Earl Johanknecht | Optometrist | 269 Memorial Dr, Suite 103, Berlin, WI 54923 | 2007-01-16 |
| 1043314677 | William Harold Hastreiter | Dentist | 102 W Huron St, Berlin, WI 54923 | 2006-09-12 |
| 1699725333 | Kurt Alan Zemke | Dentist | 280 South Church St, Berlin, WI 54923 | 2006-05-11 |
| 1942280821 | Dina N Nelson | Nurse Anesthetist, Certified Registered | 225 Memorial Drive, Anesthesia Dept, Berlin, WI 54923 | 2006-01-18 |
| 1679574453 | Craig Batley | Family Medicine | W832 Hwy 91, Suite 3, Berlin, WI 54923 | 2005-08-03 |
| 1760887392 | Waushara Dental Associate Sc | Dentist | 322 Broadway, Berlin, WI 54923 | 2014-10-24 |
| 1750673513 | Kristy E Wagner | Occupational Therapy Assistant | 225 Memorial Drive, Berlin, WI 54923 | 2011-05-11 |
| Find all providers in zip 54923 | ||||
| Taxonomy Code | 261QM1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Multi-Specialty |
| Definition to come... |
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| 1891106092 | Wisconsin Wellness Clinic | Clinic/Center | 280 Regency Ct, Suite 100, Brookfield, WI 53045-6165 | 2014-05-11 |
| 1437317708 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1160 Service Rd, Kiel, WI 53042 | 2008-05-23 |
| 1679731954 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | 1128 E Parkway Ave, Oshkosh, WI 54901 | 2008-05-23 |
| 1669639142 | Ascension Medical Group-fox Valley Wisconsin, Inc | Clinic/Center | N9642 County Rd N, Appleton, WI 54915 | 2008-05-21 |
| Find all providers with the same taxonomy | ||||
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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.