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PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
NPI 1366420531
General Acute Care Hospital in Oconomowoc, WI

Active since January 06, 2006CLIA Certified · 5 labs
791 SUMMIT AVE, OCONOMOWOC, WI 53066(262) 928-2510(262) 928-4032 Get Directions Write a Review

NPPES record last updated: May 6, 2020. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Prohealth Oconomowoc Memorial Hospital, Inc. NPPES

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

PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC. (NPI 1366420531) is a healthcare organization registered as a general acute care hospital in Oconomowoc, Wisconsin and active in the NPI registry since January 2006. The organization holds 5 active CLIA laboratory certificates and lists Susan A Edwards, Ceo, as its authorized official.

NPPES Registry Identity

NPI1366420531
Entity TypeOrganization
Primary Taxonomy282N00000X
Legal Business NamePROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Location Address791 SUMMIT AVEOconomowoc, WI 53066
Mailing Address791 Summit AveOconomowoc, WI 53066-3844 · (262) 928-2510 · Fax (262) 928-4032
Phone(262) 928-2510
Fax(262) 928-4032
Organization SubpartNo
Authorized OfficialSusan A EdwardsCeo · (262) 928-2263
Enumeration DateJanuary 6, 2006
Last NPPES UpdateMay 6, 2020
NPPES CertifiedMay 6, 2020
✔ NPI 1366420531 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral Acute Care HospitalHospitals
Taxonomy Code282N00000X
License✔ Licensed in WI · 113
Definition

An acute general hospital is an institution whose primary function is to provide inpatient diagnostic and therapeutic services for a variety of medical conditions, both surgical and non-surgical, to a wide population group. The hospital treats patients in an acute phase of illness or injury, characterized by a single episode or a fairly short duration, from which the patient returns to his or her normal or previous level of activity.

791 SUMMIT AVE, Oconomowoc, WI 53066
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Other Identifiers 1

Medicaid11011100WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Network Health, UnitedHealthcare.Insurance ›

CLIA Laboratory Certificates CMS CLIA 5

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 for Provider-Performed Microscopy Procedures (PPMP) 52D2293407

Prohealth Oconomowoc Memorial Hospital, Inc - Birthing Center · Oconomowoc, WI
Active · expires Nov 7, 2027
CLIA Number52D2293407
Laboratory TypeHospital
Certificate Effective DateNovember 8, 2025
Certificate Expiration DateNovember 7, 2027
Laboratory DirectorDr. Courtney Lemieux
Laboratory Phone(262) 928-8389
Laboratory LocationProhealth Oconomowoc Memorial Hospital, Inc - Birthing Center791 Summit Avenue Third Floor, Oconomowoc, WI 53066
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Waiver 52D2230254

Prohealth Oconomowoc Memorial Hospital, Inc - Wound Services · Oconomowoc, WI
Active · expires Jul 20, 2027
CLIA Number52D2230254
Laboratory TypeHospital Outpatient Dept
Certificate Effective DateJuly 21, 2025
Certificate Expiration DateJuly 20, 2027
Laboratory DirectorDr. Stanley Markus
Laboratory Phone(262) 928-8889
Laboratory LocationProhealth Oconomowoc Memorial Hospital, Inc - Wound Services1185 Corporate Center Drive, Suite 135, Oconomowoc, WI 53066
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 52D2152540

Prohealth Oconomowoc Memorial Hospital, Inc - Women's Services · Oconomowoc, WI
Active · expires Jul 16, 2027
CLIA Number52D2152540
Laboratory TypeHospital
Certificate Effective DateJuly 17, 2025
Certificate Expiration DateJuly 16, 2027
Laboratory DirectorDr. Sarit O. Aschkenazi-Steinberg
Laboratory Phone(262) 928-4683
Laboratory LocationProhealth Oconomowoc Memorial Hospital, Inc - Women's Services785 Summit Avenue, Suite 101, Oconomowoc, WI 53066
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 52D0388564

Prohealth Oconomowoc Memorial Hospital, Inc · Oconomowoc, WI
Active · expires Feb 8, 2027
CLIA Number52D0388564
Laboratory TypeHospital
Certificate Effective DateFebruary 9, 2025
Certificate Expiration DateFebruary 8, 2027
Laboratory DirectorDr. Sherri J. Mann
Laboratory Phone(262) 569-0628
Laboratory LocationProhealth Oconomowoc Memorial Hospital, Inc791 E Summit Ave, Oconomowoc, WI 53066
CLIA data matches this NPI record on: Name
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 52D2125221

Prohealth Oconomowoc Memorial Hospital, Inc- Interventional Pain Management Services · Oconomowoc, WI
Active · expires Feb 1, 2027
CLIA Number52D2125221
Laboratory TypePhysician Office
Certificate Effective DateFebruary 2, 2025
Certificate Expiration DateFebruary 1, 2027
Laboratory DirectorDr. Louis F. Noto
Laboratory Phone(262) 928-7312
Laboratory LocationProhealth Oconomowoc Memorial Hospital, Inc- Interventional Pain Management Services1185 Corporate Center Dr, Suite 240, Oconomowoc, WI 53066
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 8

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

EVGENIYA KHEN NP
Nurse Practitioner (Acute Care)
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-9400
THOMAS RUFFALO PA
Physician Assistant
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-9119
DR. TERRENCE J GAYNOR M.D.
Anesthesiology
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-9400
DR. RICHARD MORRIS HANSEN MD
Internal Medicine (Hematology & Oncology)
791 SUMMIT AVE, PROHEALTH CARE REGIONAL CANCER CENTER
OCONOMOWOC, WI 53066
Waukesha County (262) 569-0554
LAKE COUNTRY PHARMACY
Pharmacist
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-0284
NORHAN MOHAMMED M.D.
Internal Medicine (Cardiovascular Disease)
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-9400
JAMES JOSEPH HARPER M.D.
Emergency Medicine
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-0251
PROHEALTH OCONOMOWOC MEMORIAL HOSPITAL, INC.
Pharmacy (Institutional Pharmacy)
791 SUMMIT AVE
OCONOMOWOC, WI 53066
Waukesha County (262) 569-0471

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 Prohealth Oconomowoc Memorial Hospital, Inc.'s NPI number?

The NPI number for Prohealth Oconomowoc Memorial Hospital, Inc. is 1366420531. It was assigned to this organization in the NPPES registry on January 6, 2006.

Where is Prohealth Oconomowoc Memorial Hospital, Inc. located?

Prohealth Oconomowoc Memorial Hospital, Inc. is located at 791 Summit Ave, Oconomowoc, WI 53066. The listed phone number is (262) 928-2510.

What is Prohealth Oconomowoc Memorial Hospital, Inc.'s specialty?

The primary specialty registered for this NPI is General Acute Care Hospital with taxonomy code 282N00000X.

Does Prohealth Oconomowoc Memorial Hospital, Inc. hold CLIA laboratory certificates?

Yes. 5 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Prohealth Oconomowoc Memorial Hospital, Inc. accept?

Health plans from Anthem Blue Cross and Blue Shield, Network Health and UnitedHealthcare list Prohealth Oconomowoc Memorial Hospital, Inc. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Prohealth Oconomowoc Memorial Hospital, Inc. was last updated on May 6, 2020. NPI Profile syncs with the weekly NPPES data releases published by CMS.