NPIMap

Organization Active NPI

Scenic Bluffs Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cashton, WI
National Provider Identifier
1104890078
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SCENIC BLUFFS HEALTH CENTER, INC.
Practice address
238 Front St
Cashton, WI 54619
Phone
(608) 654-5100
Fax
(608) 654-5120
NPI assigned
Feb 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2024

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

Authorized official

Name
Mrs. Kimberly Hawthorne
Title
Ceo
Phone
(608) 654-5100

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

238 Front St
Cashton, WI 54619

Mailing address

PO Box 39
Cashton, WI 54619-0039
Phone (608) 654-5100

Other identifiers 2

IdentifierTypeStateIssuer
33247200MedicaidWI
32955800MedicaidWI

Other names 1

  • Scenic Bluffs Community Health Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20050127001057 WI Part B Supplier - Clinic/Group Practice 8325098296 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
Practice locations: Cashton, WI; Norwalk, WI
O20070904000737 WI Part A Provider - Federally Qualified Health Center (FQHC) 8325098296 2 other NPIs on this enrollment
Practice locations: Cashton, WI
O20070904000738 WI Part A Provider - Federally Qualified Health Center (FQHC) 8325098296 2 other NPIs on this enrollment
Practice locations: Norwalk, WI

Federally qualified health center certification: CCN 521808

Legal name
SCENIC BLUFFS HEALTH CENTER INC
Doing business as
SCENIC BLUFFS COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 1994
Last certification
Apr 1, 1994
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 3, 1993 in WI
Enrollment address
238 Front St
Cashton, WI 54619-2002

Federally qualified health center certification: CCN 521815

Legal name
SCENIC BLUFFS HEALTH CENTER INC
Doing business as
NORWALK COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 8, 1997
Last certification
Dec 8, 1997
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 3, 1993 in WI
Enrollment address
200 W North St
Norwalk, WI 54648-8287

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

916 Ferry St
La Crosse, WI 54601
Phone (608) 519-4621

238 FRNT St N
La Crosse, WI 54601

200 W North St
Norwalk, WI 54648
Phone 6086545100 ext. 226

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Dustin William Hundt Individual Corporate Officer May 22, 2024
Sandra Canelo Arriola Individual Corporate Officer Jun 28, 2023
Andre Paquette Individual Corporate Officer Jan 25, 2023
Michael Stewart Windle Individual Corporate Officer Aug 10, 2022
Hetti Anna Brown Individual Corporate DirectorBoard Member May 16, 2019
Matthew Bersagel Braley Individual Corporate DirectorBoard Member Jul 22, 2020
Rebecca Lyn Gretebeck Individual Corporate DirectorBoard Member May 18, 2017
Melvin Schmitz Individual Corporate DirectorBoard Member May 16, 2019
Robert Sanders Individual Corporate Officer Jan 25, 2023
Judith L Zabel Individual Corporate DirectorBoard Member May 16, 2019
Scenic Bluffs Health Center Inc Organization, Cashton, WI Non-profit Operational/Managerial Control Apr 1, 1994
Kimberly a Hawthorne Individual Corporate OfficerCeo Dec 13, 2021
W-2 Managing EmployeeCeo Dec 13, 2021
Daria M Sztaba Individual Corporate DirectorCfo Oct 28, 2024
W-2 Managing EmployeeAd;Cfo Oct 28, 2024 100%
Corporate Officer Oct 28, 2024
W-2 Managing EmployeeAd;Cfo Oct 28, 2024
Sonya Lenzendorf Individual Corporate DirectorBoard Member May 25, 2022
Ivan Agustin Munguia Torres Individual Corporate Officer May 22, 2024

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Scenic Bluffs Health Center IncLa Crosse, WI, CCN 521050 Federally qualified health center Operational/Managerial Control Jan 4, 1994

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1104890078",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 39",
            "city": "CASHTON",
            "state": "WI",
            "postal_code": "546190039",
            "telephone_number": "608-654-5100",
            "fax_number": "608-654-5120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 FRONT ST",
            "city": "CASHTON",
            "state": "WI",
            "postal_code": "54619",
            "telephone_number": "608-654-5100",
            "fax_number": "608-654-5120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCENIC BLUFFS HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-15",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "HAWTHORNE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "608-654-5100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33247200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32955800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Scenic Bluffs Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Scenic Bluffs Community Health Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cashton, WI

Sources for this page

Verify at the official NPI Registry.