SSM HEALTH FOND DU LAC REGIONAL CLINIC
NPI 1750326203
Durable Medical Equipment & Medical Supplies in Waupun, WI

NPI Status: Active since June 18, 2006

Contact Information

608 W BROWN ST
WAUPUN, WI
ZIP 53963
Phone: (920) 324-6800

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  • Organization
  • Durable Medical Equipment & Medical Supp...
  • CLIA Number: 52D2295259
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 12-06-2025

About SSM HEALTH FOND DU LAC REGIONAL CLINIC

This page provides the complete NPI Profile along with additional information for Ssm Health Fond Du Lac Regional Clinic, a provider established in Waupun, Wisconsin operating as a Durable Medical Equipment & Medical Supplies. The healthcare provider is registered in the NPI registry with number 1750326203 assigned on June 2006. The practitioner's primary taxonomy code is 332B00000X. The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Ssm Health Fond Du Lac Regional Clinic. The authorized official of this NPI record is Amy Grinnell (Vp-finance, Cfo)

NPI
1750326203
Provider Legal Name
AGNESIAN HEALTHCARE INC
Other Organization Name
SSM HEALTH FOND DU LAC REGIONAL CLINIC
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
608 W BROWN ST WAUPUN, WI 53963
Location Phone
(920) 324-6800
Mailing Address
1808 W BELTLINE HWY MADISON, WI 53713
Mailing Phone
(608) 250-1593
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
06-18-2006
Last Update Date
06-06-2024
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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

Durable Medical Equipment & Medical Supplies

Taxonomy Code
332B00000X
Type
Suppliers
Taxonomy Description
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.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

AMY GRINNELL

Authorized Official Title
VP-FINANCE, CFO
Authorized Official Phone
(608) 260-3586

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
52D2295259
Facility Type
Physician Office
Certificate Effective Date
December 07, 2023
Certificate Expiration Date
December 06, 2025
Laboratory Director
NICHOLAS THANOS
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Ssm Health Fond Du Lac Regional Clinic to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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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 1750326203, we treat the final digit (3) 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 47. The final step is to find the difference between that total and the next multiple of ten (50 - 47 = 3).

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.

Pos 1
1
Doubled → 2
Pos 2
7
Unchanged
Pos 3
5
Doubled → 10 → 1 + 0
Pos 4
0
Unchanged
Pos 5
3
Doubled → 6
Pos 6
2
Unchanged
Pos 7
6
Doubled → 12 → 1 + 2
Pos 8
2
Unchanged
Pos 9
0
Doubled → 0
Check
3
Target digit
Regular digit Doubled digit Check digit

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.

1 → 2 5 → 10 → 1 3 → 6 6 → 12 → 3 0 → 0

Step 2: Add all digits plus the NPI constant

Add the transformed values, the unchanged digits, and the constant 24.

2 + 7 + 1 + 0 + 0 + 6 + 2 + 1 + 2 + 2 + 0 + 24 = 47

Step 3: Find the amount needed to reach the next multiple of 10

The next multiple of ten after 47 is 50. The difference is the calculated check digit.

50 - 47 = 3
This NPI is valid
The calculated check digit is 3, which matches the last digit of 1750326203.

Other Providers at the Same Location


The following 20 providers are registered at the same or a nearby location.

Orthopaedic Surgery
608 W BROWN ST
WAUPUN, WI 53963
Internal Medicine (Nephrology)
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Physician Assistant
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Orthopaedic Surgery
608 W BROWN ST
WAUPUN, WI 53963
Obstetrics & Gynecology
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Surgery
608 W BROWN ST
WAUPUN, WI 53963
Podiatrist (Foot & Ankle Surgery)
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Nurse Practitioner (Family)
608 W BROWN ST
WAUPUN, WI 53963
Orthopaedic Surgery
608 W BROWN ST
WAUPUN, WI 53963
Family Medicine
608 W BROWN ST
WAUPUN, WI 53963
Nurse Practitioner
608 W BROWN ST
WAUPUN, WI 53963
Nurse Practitioner
608 W BROWN ST
WAUPUN, WI 53963
Optometrist
608 W BROWN ST
WAUPUN, WI 53963
Obstetrics & Gynecology
608 W BROWN ST
WAUPUN, WI 53963

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1750326203, enumerated as an "organization" on June 18, 2006.

The provider is located at 608 W BROWN ST WAUPUN, WI 53963 and the phone number is (920) 324-6800.

Durable Medical Equipment & Medical Supplies with taxonomy code 332B00000X.