SSM HEALTH FOND DU LAC REGIONAL CLINIC
NPI 1730162991
Family Medicine in Fond Du Lac, WI
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
Specialties & Licenses 15
Other Names 1
Other Identifiers 3
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Ssm Health Fond Du Lac Regional Clinic is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
604Medicare enrollment records show 604 clinicians reassign Medicare billing to Ssm Health Fond Du Lac Regional Clinic, which bills Medicare for the services they deliver. Of these, 135 practice at this address and 239 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 49
Nearest to this location (20)
See all 604Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 LLCDoes 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.
Medicare Product Categories
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.
Is Agnesian Healthcare Inc enrolled in Medicare?
Yes. Agnesian Healthcare Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Agnesian Healthcare Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 604 clinicians in 49 Medicare specialties reassign their Medicare billing to Agnesian Healthcare Inc. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (159), Psychiatry (40) and Family Practice (35). Of these, 135 practice at this address and 239 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, Dean Health Plan, 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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Ssm Health Fond Du Lac Regional Clinic · NPI 1730162991
Family Medicine organization in Fond Du Lac, Wisconsin. Organization record, active in the CMS NPPES registry since November 22, 2005.
## Identity
- **NPI:** 1730162991 (Entity type: Organization)
- **Enumerated:** November 22, 2005
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Legal business name:** Agnesian Healthcare Inc
- **Organization subpart:** No
- **Authorized official:** Amy Grinnell, VP-FINANCE, CFO
## Practice location
- **Address:** 420 E DIVISION ST, Fond Du Lac, WI 54935-4560
- **Phone:** (920) 923-7400
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 604 clinicians in 49 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (159), Psychiatry (40), Family Practice (35); 135 practice at this address and 239 within 10 miles; [full list](https://npiprofile.com/npi/1730162991/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 5, 2024
- **Other identifiers:** Medicaid 32841900 (WI); Other CY0124 (WI); Medicaid 38437100 (WI)
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Source: [NPI Profile](https://npiprofile.com/npi/1730162991) · Data from the CMS NPPES public registry.