CCN: 520071 NPI: 1811916281 Organization

FORT MEMORIAL HOSPITAL

611 SHERMAN AVE E
FORT ATKINSON, WI 535381960

Contact Information

Phone 9205685000
Fax 9205685412
Enumeration Date 2006-07-18
Last Updated 2024-08-09

Taxonomies

Code: 261QM1300X
Code: 282N00000X (Primary) License State: WI License: 1908-800

Inpatient Payment Attributes (IPSF) View Dictionary →

Effective Date:

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.388

medicaidRatio 0.207

uncompensatedCareAmount 971.4

vbpAdjustment 1.0091931073

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.388

medicaidRatio 0.207

uncompensatedCareAmount 971.4

vbpAdjustment 1.0091931073

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.388

medicaidRatio 0.207

uncompensatedCareAmount 971.4

vbpAdjustment 1.0091931073

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.388

medicaidRatio 0.207

uncompensatedCareAmount 555.86

vbpAdjustment 0.9993910628

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.399

medicaidRatio 0.2071

uncompensatedCareAmount 555.86

vbpAdjustment 0.9993910628

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.399

medicaidRatio 0.2071

uncompensatedCareAmount 555.86

vbpAdjustment 0.9993910628

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.399

medicaidRatio 0.2071

uncompensatedCareAmount 555.86

vbpAdjustment 0.9993910628

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.399

medicaidRatio 0.2071

uncompensatedCareAmount 317.97

vbpAdjustment 1.0084716293

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.36

medicaidRatio 0.1387

uncompensatedCareAmount 317.97

vbpAdjustment 1.0084716293

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.36

medicaidRatio 0.1387

uncompensatedCareAmount 317.97

vbpAdjustment 1.0084716293

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.325

medicaidRatio 0.1387

uncompensatedCareAmount 317.97

vbpAdjustment 1.0084716293

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.325

medicaidRatio 0.1387

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.371

medicaidRatio 0.1727

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.371

medicaidRatio 0.1727

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.371

medicaidRatio 0.1727

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.371

medicaidRatio 0.1727

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.366

medicaidRatio 0.1727

uncompensatedCareAmount 205.24

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.366

medicaidRatio 0.1727

uncompensatedCareAmount 152.72

hhrAdjustment 0.9995

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.396

medicaidRatio 0.1691

uncompensatedCareAmount 152.72

hhrAdjustment 0.9995

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.396

medicaidRatio 0.1691

uncompensatedCareAmount 152.72

hhrAdjustment 0.9995

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.396

medicaidRatio 0.1691

uncompensatedCareAmount 152.72

hhrAdjustment 0.9995

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.396

medicaidRatio 0.1691

uncompensatedCareAmount 1784.46

vbpAdjustment 1.0141084582

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.37

medicaidRatio 0.2628

uncompensatedCareAmount 1784.46

vbpAdjustment 1.0141084582

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.367

medicaidRatio 0.2628

uncompensatedCareAmount 1784.46

vbpAdjustment 1.0141084582

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.367

medicaidRatio 0.2628

uncompensatedCareAmount 331.01

vbpAdjustment 1.0091151994

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.367

medicaidRatio 0.1733

uncompensatedCareAmount 331.01

vbpAdjustment 1.0091151994

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.374

medicaidRatio 0.1733

uncompensatedCareAmount 331.01

vbpAdjustment 1.0091151994

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.374

medicaidRatio 0.1733

uncompensatedCareAmount 331.01

vbpAdjustment 1.0091151994

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.374

medicaidRatio 0.1733

uncompensatedCareAmount 414.31

vbpAdjustment 1.0088694887

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.374

medicaidRatio 0.1733

uncompensatedCareAmount 414.31

vbpAdjustment 1.0088694887

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.434

medicaidRatio 0.1845

uncompensatedCareAmount 414.31

vbpAdjustment 1.0088694887

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.434

medicaidRatio 0.1845

uncompensatedCareAmount 414.31

vbpAdjustment 1.0088694887

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.434

medicaidRatio 0.1845

uncompensatedCareAmount 383.59

vbpAdjustment 1.0127392748

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.434

medicaidRatio 0.1619

uncompensatedCareAmount 383.59

vbpAdjustment 1.0127392748

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.387

medicaidRatio 0.1619

uncompensatedCareAmount 383.59

vbpAdjustment 1.0127392748

hhrAdjustment 1.0

censusDivision 4

cbsaActualGeographicLocation 52

providerType 00

caseMixIndex 1.2017

operatingCostToChargeRatio 0.387

medicaidRatio 0.1619

uncompensatedCareAmount 383.59

vbpAdjustment 1.0127392748

hhrAdjustment 1.0

Outpatient Payment Attributes (OPSF) View Dictionary →

Effective Date:

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.198

deviceCostToChargeRatio 0.55

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.198

deviceCostToChargeRatio 0.55

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.208

deviceCostToChargeRatio 0.604

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.208

deviceCostToChargeRatio 0.604

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.239

deviceCostToChargeRatio 0.618

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.239

deviceCostToChargeRatio 0.618

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.236

deviceCostToChargeRatio 0.618

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.24

deviceCostToChargeRatio 0.64

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.24

deviceCostToChargeRatio 0.64

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.237

deviceCostToChargeRatio 0.636

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.254

deviceCostToChargeRatio 0.5

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.254

deviceCostToChargeRatio 0.5

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.244

deviceCostToChargeRatio 0.44

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.243

deviceCostToChargeRatio 0.439

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.243

deviceCostToChargeRatio 0.439

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.293

deviceCostToChargeRatio 0.461

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.293

deviceCostToChargeRatio 0.461

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.303

deviceCostToChargeRatio 0.453

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.453

deviceCostToChargeRatio 0.468

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

cbsaActualGeographicLocation 52

providerType 00

operatingCostToChargeRatio 0.304

deviceCostToChargeRatio 0.468

specialPaymentIndicator Y

costOfLivingAdjustment 0.797

carrierCode 06302

localityCode 00

FORT MEMORIAL HOSPITAL

Contact Information

Taxonomies

Inpatient Payment Attributes (IPSF) View Dictionary →

Outpatient Payment Attributes (OPSF) View Dictionary →

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