WAUSHARA FAMILY PHYSICIANS
NPI 1710018817
Non-Pharmacy Dispensing Site in Wild Rose, WI
NPI Status: Active since March 08, 2007
Contact Information
701 GROVE AVE
WILD ROSE, WI
ZIP 54984
Phone: (920) 622-6013
Fax: (920) 774-1026
- Organization
- Non-Pharmacy Dispensing Site
- Accepts Insurance
- CLIA Number: 52D0398014
- CLIA Cert. Type: Hospital
- CLIA Exp. Date: 02-15-2027
About WAUSHARA FAMILY PHYSICIANS
This page provides the complete NPI Profile along with additional information for Waushara Family Physicians, a provider established in Wild Rose, Wisconsin operating as a Non-pharmacy Dispensing Site. The healthcare provider is registered in the NPI registry with number 1710018817 assigned on March 2007. The practitioner's primary taxonomy code is 332900000X with license number 47322-20 (WI). The provider is registered as an organization and their NPI record was last updated 11 years ago. The provider's is doing business as Waushara Family Physicians. The authorized official of this NPI record is Jenifer Danzeisen Rn (Clinic Manager/ Director Of Nu)
- NPI
- 1710018817
- Provider Legal Name
- THEDACARE MEDICAL CENTER - WILD ROSE, INC
- Other Organization Name
- WAUSHARA FAMILY PHYSICIANS
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 701 GROVE AVE WILD ROSE, WI 54984
- Location Phone
- (920) 622-6013
- Location Fax
- (920) 774-1026
- Mailing Address
- PO BOX 314 WILD ROSE, WI 54984
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-08-2007
- Last Update Date
- 07-31-2015
- Code Navigator
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
Non-Pharmacy Dispensing Site
- Taxonomy Code
- 332900000X
- Type
- Suppliers
- License No.
- 47322-20
- License State
- WI
- Taxonomy Description
- A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - EPO
- CareSource (Common Ground Healthcare) Bronze $0 Ded / $2500 Rx Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - EPO
- CareSource (Common Ground Healthcare) Bronze $9600 ($45 PCP Copay) - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - EPO
- CareSource (Common Ground Healthcare) Bronze Standard $7500 - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - EPO
- CareSource (Common Ground Healthcare) Gold $0 Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - EPO
- CareSource (Common Ground Healthcare) Gold $3300 - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Gold Standard $2000 - EPO
- CareSource (Common Ground Healthcare) Gold Standard $2000 - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded - EPO
- CareSource (Common Ground Healthcare) Silver $4700 Ded / $5000 Rx Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded - EPO
- CareSource (Common Ground Healthcare) Silver $5000 Ded / $6000 Rx Ded - Vision Exam - EPO
- CareSource (Common Ground Healthcare) Silver Standard $6000 - EPO
- CareSource (Common Ground Healthcare) Silver Standard $6000 - Vision Exam - EPO
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 |
|---|---|---|---|
| 2115407 | OTHER (01) | PK |
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
- 52D0398014
- Facility Type
- Hospital
- Certificate Effective Date
- February 16, 2025
- Certificate Expiration Date
- February 15, 2027
- Laboratory Director
- DR. ERIC M. DESTRAMPE
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Waushara Family Physicians after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that 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 1710018817, we treat the final digit (7) 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 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
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 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 11 providers are registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1710018817, enumerated as an "organization" on March 08, 2007.
The provider is located at 701 GROVE AVE WILD ROSE, WI 54984 and the phone number is (920) 622-6013.
Non-Pharmacy Dispensing Site with taxonomy code 332900000X.
The provider might be accepting Accepts: CareSource (Common Ground Healthcare), Medicare. Please consult your insurance carrier or call the provider to verify.
