WOODSIDE LUTHERAN HOME
NPI 1780756890
Skilled Nursing Facility in Green Bay, WI
Overall Rating: 4 out of 5 stars
NPI Status: Active since November 14, 2006
Contact Information
1040 PILGRIM WAY
GREEN BAY, WI
ZIP 54304
Phone: (920) 499-1481
Fax: (920) 499-1501
- Organization
- Skilled Nursing Facility
- Accepts Insurance
- CLIA Number: 52D0669074
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 08-31-2026
About WOODSIDE LUTHERAN HOME
This page provides the complete NPI Profile along with additional information for Woodside Lutheran Home, a provider established in Green Bay, Wisconsin operating as a Skilled Nursing Facility. The healthcare provider is registered in the NPI registry with number 1780756890 assigned on November 2006. The practitioner's primary taxonomy code is 314000000X with license number 2177 (WI). The provider is registered as an organization and their NPI record was last updated 2 years ago. The provider's is doing business as Woodside Lutheran Home. The authorized official of this NPI record is Polly Gretzinger (Executive Director, Campus Operatio)
- NPI
- 1780756890
- Provider Legal Name
- BAY AREA LUTHERAN HOMES INC
- Other Organization Name
- WOODSIDE LUTHERAN HOME
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 1040 PILGRIM WAY GREEN BAY, WI 54304
- Location Phone
- (920) 499-1481
- Location Fax
- (920) 499-1501
- Mailing Address
- 1040 PILGRIM WAY GREEN BAY, WI 54304
- Mailing Phone
- (920) 499-1481
- Mailing Fax
- (920) 499-1501
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 11-14-2006
- Last Update Date
- 10-13-2023
- Code Navigator
According to the Nursing Home Compare program data, Woodside Lutheran Home has an above average overall quality rating based on the provider's performance on three separate measures including: health inspections, staffing, and quality of resident care information. These quality measures, combined in a star rating of 4 out of 5 stars provide a snapshot of this nursing home quality.
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
Skilled Nursing Facility
- Taxonomy Code
- 314000000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 2177
- License State
- WI
- Taxonomy Description
- (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Silver Preferred/Broad 4000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5300 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network - EPO
- CGHC Bronze $0 Ded / $2250 Rx Ded - Envision Network (Vision Exam) - EPO
- CGHC Bronze $9200 ($40 PCP Copay) - Envision Network - EPO
- CGHC Bronze $9200 ($40 PCP Copay) - Envision Network (Vision Exam) - EPO
- CGHC Bronze Standard $7500 - Envision Network - EPO
- CGHC Bronze Standard $7500 - Envision Network (Vision Exam) - EPO
- CGHC Catastrophic $9200 - Envision Network - EPO
- CGHC Gold $0 Ded - Envision Network - EPO
- CGHC Gold $0 Ded - Envision Network (Vision Exam) - EPO
- CGHC Gold $3000 - Envision Network - EPO
- Prevea360 Bronze HSA - HMO
- Prevea360 Bronze Share - HMO
- Prevea360 Catastrophic - HMO
- Prevea360 Expanded Bronze Standard - HMO
- Prevea360 Gold HSA - HMO
- Prevea360 Gold Share - HMO
- Prevea360 Gold Standard - HMO
- Prevea360 Silver $0 Copay PCP Visits - HMO
- Prevea360 Silver Share - HMO
- Prevea360 Silver Standard - HMO
- Gold 1 - HMO
- Gold 1 with Adult Vision Services - HMO
- Gold 8 - HMO
- Silver 1 - HMO
- Silver 1 with Adult Vision Services - HMO
- Silver 12 with First 4 Primary Care Visits Free - HMO
- Silver 8 - HMO
- Enrich $1,500 - 25% - HMO
- Enrich $3,500 - 30% - HMO
- Enrich $4,100 HDHP - HMO
- Enrich $5,000 - 40% - HMO
- Enrich $6,200 HDHP - HMO
- Enrich $7,500 - HMO
- Enrich $9,200 - HMO
- Enrich Protection - HMO
- Premier $1,500 - 25% - HMO
- Premier $3,500 - 30% - HMO
- UHC Bronze Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, No Referrals) - HMO
- UHC Bronze Copay Focus+ $0 Indiv Med Ded ($0 Virtual Urgent Care, Dental + Vision, No Referrals) - HMO
- UHC Bronze Standard (No Referrals) - HMO
- UHC Bronze Value HSA (No Referrals) - HMO
- UHC Gold Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Gold Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
- UHC Gold Copay Focus $0 Indiv Med Ded ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Gold Standard (No Referrals) - HMO
- UHC Silver Advantage ($0 Virtual Urgent Care, $3 Tier 2 Rx, No Referrals) - HMO
- UHC Silver Advantage+ ($0 Virtual Urgent Care, $3 Tier 2 Rx, Dental + Vision, No Referrals) - HMO
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 |
|---|---|---|---|
| 20150200 | MEDICAID (05) | WI |
Nursing Home Quality Information
The Centers for Medicare and Medicaid Services publishes the Nursing Home Compare star rating data to provide consumers an easy way to compare nursing home's quality of care.
| Overall Quality Rating | - 4 out of 5 stars - Above Average |
| The overall star rating is based on a nursing homes's performance on health inspections, staffing and quality measures. | |
| Health Inspection Rating | Not Available |
| The health inspection star rating is based on a nursing home’s weighted score from the most recent health inspections. | |
| Quality Measures Rating | - 3 out of 5 stars - Average |
| The quality measures star rating is based on data from a select set of clinical measures. | |
| Long-Stay Quality Measures Rating | - 2 out of 5 stars - Below Average |
| The long-stay quality of care rating is based on the quality of care delivered to long-term residents only. | |
| Short-Stay Quality Measures Rating | - 4 out of 5 stars - Above Average |
| The short-stay quality of care rating is based on the quality of care delivered to temporary residents only. | |
| Staffing Rating | - 5 out of 5 stars - Much Above Average |
| The staffing rating is based on the star rating based on the nursing home’s staffing hours for Registered Nurses (RNs), Licensed Practice Nurses (LPNs), Licensed Vocational Nurses (LVNs) and Nurse aides. | |
| Nurse Aide Staffing Hours | 3.02 hours per resident per day |
| Nurse aide hours per resident per day. Higher number of hours are better. | |
| RN Staffing Hours | 1.38 hours per resident per day |
| Resgistered nurse hours per resident per day. Higher number of hours are better. | |
| RN Staff Turnover | 20% |
| Resgistered nurse turnover is the percentage of registered nursing staff who stop working at the facility within a given year. | |
| Ownership Type | Non profit - Church related |
| Is the facility private for profit, not-for profit or publicly owned. | |
| Number of Certified Beds | 130 beds |
| Number of beds in the nursing home that have been approved by the federal government to participate in the Medicare or Medicaid programs. | |
| Residents per Day | 104 residents |
| Average number of residents living in the facility per day. | |
| Automatic Sprinkler Systems | Yes |
| Does the facility have automatic sprinkler systems in all required areas? | |
| Facility Reported Incidents | 0 incidents |
| Number of facility-reported incidents in the past 3 years. A lower number is better. | |
| Substantiated Complaints | 4 complaints |
| Number of substantiated complaints in the past 3 years. A lower number is better. | |
| Citations from Inspections | 1 citations after infection control inspection |
| Number of citations from infection control inspections in the past 3 years. A lower number is better. | |
| Total Number of Penalties | 1 penalties from a serious health, fire safety or long-term unresolved citation |
| The Medicare program may impose penalties on a facilty when there's serious health or fire safety citations or if the facility fails to correct a citation for a long period of time. | |
| Number of Fines | 1 fines |
| Toal number of fines in the last 3 years. A penalty can be a fine against the facility or denied payments from Medicare. | |
| Amount of Fines | $29807.70 |
| Total monetary amount of fine imposed on the facility in the last 3 years. | |
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
- 52D0669074
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- September 01, 2024
- Certificate Expiration Date
- August 31, 2026
- Laboratory Director
- MS. MEGHAN MEHLBERG
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Woodside Lutheran Home 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 Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 7 | 8 | 0 | 7 | 5 | 6 | 8 | 9 | 0 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 16 | 0 | 14 | 5 | 12 | 8 | 18 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 7 + 1 + 6 + 0 + 1 + 4 + 5 + 1 + 2 + 8 + 1 + 8 + 24 = 70 | |||||||||
| Step 3: because the number obtained in step 2 ends in zero, the check digit is zero. | |||||||||
| 0 | |||||||||
The NPI number 1780756890 is valid because the calculated check digit 0 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 17 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1982717898 | TINA MEYER Individual | Physical Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1013075142 | MRS. RAMONA DAWN SCHMIDT OTR Individual | Occupational Therapist | 1040 PILGRIM WAY WOODSIDE LUTHERAN HOME GREEN BAY, WI 54304 (920) 405-3522 |
| 1609922665 | MRS. KELLY J MALMQUIST PTA Individual | Physical Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1033386404 | MRS. VANESSA PLOEDERL COTA Individual | Occupational Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1083868244 | MRS. INGRID ANN FREITAG M.S. CCC-SLP Individual | Speech-Language Pathologist | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1740519180 | KARA J BEHM OTR Individual | Occupational Therapist | 1040 PILGRIM WAY ASHWAUBENON, WI 54304 (920) 499-1481 |
| 1912237611 | KARLA FLORES Individual | Occupational Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 499-1481 |
| 1720308026 | MARY T. ANNEN OTR Individual | Occupational Therapist | 1040 PILGRIM WAY WOODSIDE LUTHERAN HOME ASHWAUBENON, WI 54304 (920) 405-3522 |
| 1932410446 | MRS. JOAN F THIEDE P.T.A. Individual | Physical Therapy Assistant | 1040 PILGRIM WAY WOODSIDE LUTHERAN HOME GREEN BAY, WI 54304 (920) 405-3522 |
| 1184931511 | KAYLA MARTHA HENKEL COTA Individual | Occupational Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1194022731 | JENNIFER SITZMAN PTA Individual | Physical Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1700184272 | SARAH CRYSTAL BUSER COTA Individual | Occupational Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3522 |
| 1780979724 | MRS. JESSICA LYNN ATKINSON PTA Individual | Physical Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (192) 040-5352 |
| 1891277299 | KAYLA BETH BURTON OTR/L Individual | Occupational Therapist | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 499-1481 |
| 1912446618 | CHELSEA NABAK Individual | Speech-Language Pathologist | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 405-3240 |
| 1790088672 | NICOLE ANN PROKASH MS Individual | Occupational Therapist | 1040 PILGRIM WAY ASHWAUBENON, WI 54304 (920) 405-3522 |
| 1790110104 | MRS. JAYME ELLEN VAUGHAN PTA Individual | Physical Therapy Assistant | 1040 PILGRIM WAY GREEN BAY, WI 54304 (920) 499-1481 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1780756890, enumerated in the NPI registry as an "organization" on November 14, 2006
The provider is located at 1040 Pilgrim Way Green Bay, Wi 54304 and the phone number is (920) 499-1481
This medical organization specializes in Skilled Nursing Facility with taxonomy code 314000000X
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, Common Ground. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 52D0669074 for a "skilled nursing facility/nursing facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued 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..
The Overall Quality Rating for this nursing home is 4 out of 5 stars which is above average when compared to other nursing homes. The overall star rating is based on a nursing homes's performance on health inspections, staffing and quality measures.
This NPI record was last updated on November 14, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.