NPIMap

Organization Active NPI

Burnett Medical Center Inc

  • Medicare Defined Swing Bed Hospital Unit
  • Grantsburg, WI
National Provider Identifier
1003965435
Registry record updated Jan 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
Legal business name
BURNETT MEDICAL CENTER INC
Practice address
257 W Saint George Ave
Grantsburg, WI 54840-7827
Phone
(715) 463-5355
Fax
(715) 463-7305
NPI assigned
Jan 8, 2007
Last updated
Jan 4, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
BURNETT MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 4, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Charles J. Faught
Title
Cfo
Phone
(715) 463-7281

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X Primary

Addresses

Primary practice location

257 W Saint George Ave
Grantsburg, WI 54840-7827

Mailing address

257 W Saint George Ave
Grantsburg, WI 54840-7827
Phone (715) 463-5355

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111220000531 WI Part A Provider - Critical Access Hospital 2163314931 Practice locations: Grantsburg, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003965435. Details of each certification follow.

Hospital certification: CCN 52Z331

Legal name
BURNETT MEDICAL CENTER INC
Organization structure
CorporationNon-profit
Incorporated
Nov 30, 1956 in WI
Enrollment address
257W Saint George Ave
Grantsburg, WI 54840-7827

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Burnett General Hospita5 organizations share this tax ID, including this one
Part of
Burnett General Hospita

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Bremer Bank, National Association Organization, Amery, WI Financial institution 5% Or Greater Mortgage Interest Mar 23, 2007 51%
Stuart McIntosh Individual Corporate Director Jan 26, 2024 11%
Tamra J White Individual Corporate OfficerChief Administrative Officer Jun 26, 2025 11%
Kenneth Kutz Individual Corporate OfficerBoard President Jan 21, 2025 11%
David Dahlberg Individual Corporate DirectorBoard Vice President Jan 21, 2025 11%
Tanya Jensen Individual Corporate Director Jan 21, 2025 11%
Lois E Carlson Individual Corporate Director Jan 21, 2020 11%
Mark L Thayer Individual Corporate DirectorBoard Member Jan 21, 2025 12%
W-2 Managing Employee May 15, 2025
Taylor J Paap Individual Corporate Director Jan 17, 2023 11%
Megan Sandgren Individual Corporate OfficerChief Executive Officer Dec 1, 2025 11%
W-2 Managing EmployeeAd; Dec 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325635200000",
    "number": "1003965435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5355",
            "fax_number": "715-463-7305"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5355",
            "fax_number": "715-463-7305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURNETT MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BURNETT MEDICAL CENTER INC",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-01-04",
        "status": "A",
        "authorized_official_last_name": "FAUGHT",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-463-7281",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grantsburg, WI

Sources for this page

Verify at the official NPI Registry.