BLACK RIVER MEMORIAL HOSPITAL INC
NPI 1063516078
Hospice Care, Community Based in Black River Falls, WI
NPI Status: Active since September 11, 2006
Contact Information
311 COUNTY ROAD A STE 1
BLACK RIVER FALLS, WI
ZIP 54615
Phone: (715) 284-5361
Fax: (715) 284-1390
- Organization
- Hospice Care, Community Based
- Accepts Insurance
- Medicare Supplier
- Accepts Medicare Approved Payment
- CLIA Number: 52D0040042
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 01-02-2027
About BLACK RIVER MEMORIAL HOSPITAL INC
This page provides the complete NPI Profile along with additional information for Black River Memorial Hospital Inc, a provider established in Black River Falls, Wisconsin operating as a Hospice Care, Community Based. The healthcare provider is registered in the NPI registry with number 1063516078 assigned on September 2006. The practitioner's primary taxonomy code is 251G00000X with license number 1037 (WI). The provider is registered as an organization and their NPI record was last updated 10 years ago. The authorized official of this NPI record is Mary Beth White-jacobs Rn Bsn Mha Fache (President & Ceo)
- NPI
- 1063516078
- Provider Name
- BLACK RIVER MEMORIAL HOSPITAL INC
- Entity Type
- Organization
- Location Address
- 311 COUNTY ROAD A STE 1 BLACK RIVER FALLS, WI 54615
- Location Phone
- (715) 284-5361
- Location Fax
- (715) 284-1390
- Mailing Address
- 711 W ADAMS ST BLACK RIVER FALLS, WI 54615
- Mailing Phone
- (715) 284-5361
- Mailing Fax
- (715) 284-1390
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-11-2006
- Last Update Date
- 12-16-2016
- Code Navigator
Black River Memorial Hospital Inc is a medicare supplier with PTAN 20662937 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Commodes, Urinals, Bedpans or Blood Glucose Monitors/Supplies (Non-Mail Order) or Heat & Cold Applications or Hospital Beds (Electric) or Support Surfaces: Pressure Reducing Beds/Mats/Pads or Ultraviolet Light Devices and/or Supplies or Canes and/or Crutches or Walkers or Wheelchairs (Standard Manual) or Wheelchairs (Standard Manual Related Accessories) or Wheelchair Seating/Cushions or Orthoses: Off-The-Shelf or Continuous Positive Airway Pressure (CPAP) Devices or Nebulizer Equipment and/or Supplies or Oxygen Equipment and/or Supplies or Respiratory Assist Devices or Respiratory Suction Pumps.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Hospice Care, Community Based
- Taxonomy Code
- 251G00000X
- Type
- Agencies
- License No.
- 1037
- License State
- WI
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Silver Preferred/Broad 4000 ($0 PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Oak $1,300 Gold - PPO
- Oak $2,000 Standard Gold - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 521570 | MEDICARE OSCAR/CERTIFICATION (06) | ||
| 43189700 | MEDICAID (05) | WI |
Medical Equipment Supplier
The provider carries the following medical supplies product categories:
- PTAN
- 20662937
- Accepts Medicare Assignment
- YES
- Specialities List
- MSC With Respiratory Therapist.
- Provider Type List
- OXYGEN & EQUIPMENT.
- Competitive Bidding
- NO
Supplies List
- Commodes, Urinals, Bedpans - Raised toilets, Drop-arm commodes, Folding commodes, Plastic urinals, Plastic bedpans, Disposable urinals
- Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
- Heat & Cold Applications - Heat therapy, Cold therapy, Heating pads
- Hospital Beds (Electric) - Total electric hospital beds, Semi-electric hospital beds
- Support Surfaces: Pressure Reducing Beds/Mats/Pads - Group 1 – Alternating pressure pad, Air/Water/Dry pressure pad or pressure mattress. Group 2 - Pressure reducing powered air mattresses, Powered air flotation bed, non-powered pressure reducing mattress Group 3 – Air fluidized bed
- Ultraviolet Light Devices and/or Supplies - Hand-held phototherapy devices, UV light therapy panels, Multidirectional light therapy
- Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
- Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
- Wheelchairs (Standard Manual) - Standard wheelchairs, transport wheelchairs, heavy duty wheelchairs
- Wheelchairs (Standard Manual Related Accessories) - Accessories for standard wheelchairs, transport wheelchairs, heavy duty wheelchairs
- Wheelchair Seating/Cushions - Wheelchair seat cushions, Wheelchair bank cushions, Wheelchair padded armrests
- Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
- Continuous Positive Airway Pressure (CPAP) Devices - CPAP machines, Compressor systems, Humidifiers, Masks
- Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
- Oxygen Equipment and/or Supplies - Portable oxygen systems, Oxygen concentrators, Oxygen contents
- Respiratory Assist Devices -
- Respiratory Suction Pumps - Portable suction pumps, Stationary suction pumps, Canisters
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D0040042
- Facility Type
- Hospital
- Certificate Effective Date
- January 03, 2025
- Certificate Expiration Date
- January 02, 2027
- Laboratory Director
- DR. KATHYRN SWARTZ
- Certificate Type
- Certificate of Accreditation
- Certificate Type Description
- This is a CLIA certificate is issued to Black River Memorial Hospital Inc on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1063516078, we treat the final digit (8) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 42. The final step is to find the difference between that total and the next multiple of ten (50 - 42 = 8).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 42 is 50. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1063516078, enumerated as an "organization" on September 11, 2006.
The provider is located at 311 COUNTY ROAD A STE 1 BLACK RIVER FALLS, WI 54615 and the phone number is (715) 284-5361.
Hospice Care, Community Based with taxonomy code 251G00000X.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, HealthPartners,. Please consult your insurance carrier or call the provider to verify.
