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SSM HEALTH FOND DU LAC REGIONAL CLINIC
NPI 1083676217
Durable Medical Equipment & Medical Supplies in Fond Du Lac, WI

Active since April 04, 2006CLIA 52D2197672 · Waiver
421 CAMELOT DR, FOND DU LAC, WI 54935(920) 926-8332 Get Directions Write a Review

NPPES record last updated: June 5, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 5, 2024, Jan 24, 2022, May 23, 2019 (3 updates tracked since 2019).

About Ssm Health Fond Du Lac Regional Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SSM HEALTH FOND DU LAC REGIONAL CLINIC (NPI 1083676217) is a healthcare organization registered as a durable medical equipment & medical supplies in Fond Du Lac, Wisconsin and active in the NPI registry since April 2006. The organization holds a CLIA Waiver certificate valid through October 26, 2026 and lists Amy Grinnell, Vp-finance, Cfo, as its authorized official.

NPPES Registry Identity

NPI1083676217
Entity TypeOrganization
Primary Taxonomy332B00000X
Legal Business NameAGNESIAN HEALTHCARE INC
Location Address421 CAMELOT DRFond Du Lac, WI 54935-8335
Mailing Address1808 W Beltline HwyMadison, WI 53713-2334 · (608) 250-1593
Phone(920) 926-8332
Organization SubpartNo
Authorized OfficialAmy GrinnellVp-finance, Cfo · (608) 260-3586
Enumeration DateApril 4, 2006
Last NPPES UpdateJune 5, 20243 updates tracked since enumeration
NPPES CertifiedJune 5, 2024
✔ NPI 1083676217 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDurable Medical Equipment & Medical SuppliesSuppliers
Taxonomy Code332B00000X
Definition

A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient's use in the home and that are usable for an extended period of time.

421 CAMELOT DR, Fond Du Lac, WI 54935
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Other Names 1

Doing Business AsSsm Health Fond Du Lac Regional Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D2197672

Agnesian Healthcare Adult Day Services · Fond Du Lac, WI
Active · expires Oct 26, 2026
CLIA Number52D2197672
Laboratory TypeAssisted Living Facility
Certificate Effective DateOctober 27, 2024
Certificate Expiration DateOctober 26, 2026
Laboratory DirectorMs. Julie A. Schwartz
Laboratory Phone(920) 926-5099
Laboratory LocationAgnesian Healthcare Adult Day Services420 E Merill Avenue, Fond Du Lac, WI 54935
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DARIA L SONNENFELD LAT
Specialist/Technologist (Athletic Trainer)
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
AMY JO MCFADDEN PT
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
LISA M FASKA PT, MS
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
CHRISTOPHER J BLATTNER PT
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
MAREA A DRICKEN PT, OTR
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
ZACHARY T PITZ MS PT/LAT
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
GREGORY G FROUNFELTER PT
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940
AMBER J HAHN PT
Physical Therapist
421 CAMELOT DR
FOND DU LAC, WI 54935
Fond Du Lac County (920) 923-7940

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Agnesian Healthcare Inc's NPI number?

The NPI number for Agnesian Healthcare Inc is 1083676217. It was assigned to this organization in the NPPES registry on April 4, 2006.

Where is Agnesian Healthcare Inc located?

Agnesian Healthcare Inc is located at 421 Camelot Dr, Fond Du Lac, WI 54935. The listed phone number is (920) 926-8332.

What is Agnesian Healthcare Inc's specialty?

The primary specialty registered for this NPI is Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.

Does Agnesian Healthcare Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2197672) is associated with this NPI, valid through October 26, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Agnesian Healthcare Inc was last updated on June 5, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.