SSM HEALTH FOND DU LAC REGIONAL CLINIC
NPI 1730162991
Family Medicine in Fond Du Lac, WI

Active since November 22, 2005
420 E DIVISION ST, FOND DU LAC, WI 54935(920) 923-7400 Get Directions Write a Review

NPPES record last updated: June 5, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Jun 5, 2024, May 24, 2023, Jan 25, 2022 and 1 more (4 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 1730162991) is a healthcare organization registered as a family medicine in Fond Du Lac, Wisconsin and active in the NPI registry since November 2005. The organization lists Amy J Grinnell, Vp-finance, Cfo, as its authorized official.

NPPES Registry Identity

NPI1730162991
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameAGNESIAN HEALTHCARE INC
Location Address420 E DIVISION STFond Du Lac, WI 54935-4560
Mailing Address1808 W Beltline HwyMadison, WI 53713-2334 · (608) 250-1593
Organization SubpartNo
Authorized OfficialAmy J GrinnellVp-finance, Cfo · (608) 260-3586
Enumeration DateNovember 22, 2005
Last NPPES UpdateJune 5, 20244 updates tracked since enumeration
NPPES CertifiedJune 5, 2024
NPI 1730162991 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 15

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedOptometristTaxonomy 152W00000X
Also ListedAnesthesiologyTaxonomy 207L00000X
Also ListedDermatologyTaxonomy 207N00000X
Also ListedInternal MedicineTaxonomy 207R00000X
Also ListedObstetrics & GynecologyTaxonomy 207V00000X
Also ListedOphthalmologyTaxonomy 207W00000X
Also ListedOrthopaedic SurgeryTaxonomy 207X00000X
Also ListedOtolaryngologyTaxonomy 207Y00000X
Also ListedPediatricsTaxonomy 208000000X
Also ListedPhysical Medicine & RehabilitationTaxonomy 208100000X
Also ListedSurgeryTaxonomy 208600000X
Also ListedUrologyTaxonomy 208800000X
Also ListedPodiatristTaxonomy 213E00000X
Also ListedDurable Medical Equipment & Medical SuppliesTaxonomy 332B00000X
420 E DIVISION ST, Fond Du Lac, WI 54935

Other Names 1

Doing Business AsSsm Health Fond Du Lac Regional Clinic

Other Identifiers 3

Medicaid32841900WI
OtherCY0124WI · Railroad Medicare Grp #
Medicaid38437100WI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Ssm Health Pharmacy carries, from the Medicare DMEPOS supplier directory.

Ssm Health Pharmacy

DMEPOS supplier · Fond Du Lac, WIOperated by Agnesian Healthcare Enterprises LLC

Does not accept Medicare assignment

Ssm Health Pharmacy has not agreed to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients may be charged more than the Medicare-approved amount; confirm the expected cost with the supplier before ordering.

PTAN (Medicare Supplier Number)20606015
Medicare Participant SinceMarch 15, 2002
Supplier Location420 E Division StFond Du Lac, WI 54935
Supplier Specialties
Certified Other Pharmacy

Medicare Product Categories

Epoetin
Epoetin is a man-made version of human erythropoietin (EPO)
Immunosuppressive Drugs
Immunosuppressive drugs require dosage, frequency, and route of administration to prevent or treat the rejection of an organ transplant
Infusion Drugs
Nebulizer Drugs
Albuterol, levalbuterol, and metaproterenol are all short-acting bronchodilators with beta-adrenergic stimulatory effect
Oral Anticancer Drugs
FDA anticancer drugs
Oral Antiemetic Drugs
FDA antiemetic drugs
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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.

Nurse Practitioner
420 E DIVISION ST
FOND DU LAC, WI 54935
Obstetrics & Gynecology
420 E DIVISION ST
FOND DU LAC, WI 54935
Urology
420 E DIVISION ST
FOND DU LAC, WI 54935
Psychologist
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner (Psychiatric/Mental Health)
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner
420 E DIVISION ST
FOND DU LAC, WI 54935
Nurse Practitioner (Family)
420 E DIVISION ST
FOND DU LAC, WI 54935
Urology
420 E DIVISION ST
FOND DU LAC, WI 54935

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 1730162991. It was assigned to this organization in the NPPES registry on November 22, 2005. The provider is doing business as Ssm Health Fond Du Lac Regional Clinic.

Where is Agnesian Healthcare Inc located?

Agnesian Healthcare Inc is located at 420 E Division St, Fond Du Lac, WI 54935. The listed phone number is (920) 923-7400.

What is Agnesian Healthcare Inc's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Agnesian Healthcare Inc accept Medicare assignment for medical equipment?

No. As a Medicare medical equipment supplier, Ssm Health Pharmacy does not accept Medicare assignment for equipment and supplies, so patients may be charged more than the Medicare-approved amount. Confirm the expected cost with the supplier before ordering.

What insurance does Agnesian Healthcare Inc accept?

Health plans from Anthem Blue Cross and Blue Shield, HealthPartners, Network Health and Quartz list Agnesian Healthcare 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 Agnesian Healthcare Inc was last updated on June 5, 2024. NPI Profile syncs with the weekly NPPES data releases published by CMS.