NPIMap

Organization Active NPI

Scenic Bluffs Health Center, Inc

  • Dental Clinic/Center
  • Cashton, WI
National Provider Identifier
1124270178
Registry record updated Sep 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
Legal business name
SCENIC BLUFFS HEALTH CENTER, INC
Practice address
238 Front St
Cashton, WI 54619-2002
Phone
(608) 654-5100
NPI assigned
Oct 21, 2008
Organization subpart
Yes
Parent organization
SCENIC BLUFFS HEALTH CENTER, INCAs reported in NPPES

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
Kimberly Hawthrone
Title
Ceo
Phone
(605) 654-5100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X Primary

Addresses

Primary practice location

238 Front St
Cashton, WI 54619-2002

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
32955800MedicaidWI

Other names 1

  • Scenic Bluffs Community Health Centers Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070904000737 WI Part A Provider - Federally Qualified Health Center (FQHC) 8325098296 2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cashton, 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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Scenic Bluffs Health Center24 organizations share this tax ID, including this one
Part of
Scenic Bluffs Health Center

Other organizations with this tax ID 23

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

View all 23

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%
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 2

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

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726185600000",
    "number": "1124270178",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "238 FRONT ST",
            "city": "CASHTON",
            "state": "WI",
            "postal_code": "546192002",
            "telephone_number": "608-654-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SCENIC BLUFFS HEALTH CENTER, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SCENIC BLUFFS HEALTH CENTER, INC",
        "enumeration_date": "2008-10-21",
        "last_updated": "2024-09-13",
        "certification_date": "2024-09-13",
        "status": "A",
        "authorized_official_last_name": "HAWTHRONE",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "605-654-5100"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "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"
        }
    ]
}

Other providers in Cashton, WI

Sources for this page

Verify at the official NPI Registry.