NPIMap

Organization Active NPI

Kenosha Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Racine, WI
National Provider Identifier
1215823406
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Practice address
930 Dr Martin Luther King Dr # 3
Racine, WI 53404-3008
Phone
(262) 656-0044
Fax
(262) 764-3636
NPI assigned
Jun 16, 2025
Last updated
Feb 25, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
KENOSHA COMMUNITY HEALTH CENTER, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Authorized official

Name
John William Stampfl
Title
Cfo
Phone
(262) 771-3561

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Pediatric Nurse Practitioner 363LP0200X NU

Addresses

Primary practice location

930 Dr Martin Luther King Dr # 3
Racine, WI 53404-3008

Mailing address

4006 Washington Rd
Kenosha, WI 53144-4819
Phone (262) 771-3561

Other identifiers 1

IdentifierTypeStateIssuer
100328514MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250806000414 WI Part A Provider - Federally Qualified Health Center (FQHC) 0941195168 Practice locations: Racine, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1215823406. Details of each certification follow.

Federally qualified health center certification: CCN 521054

Legal name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Doing business as
PILLAR HEALTH RACINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 8, 2025
Last certification
Jul 8, 2025
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
930 Dr Martin Luther King Dr
# 3
Racine, WI 53404-3008

Other NPIs with the same Medicare PAC ID 4

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

National Provider Directory

National Provider Directory
Tax ID family
Kenosha Comm Health Ctr4 organizations share this tax ID, including this one
Part of
Kenosha Comm Health Ctr

Other organizations with this tax ID 3

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

Locations

1330 52nd St
Kenosha, WI 53140
Phone (262) 656-0044

4006 Washington Rd
Kenosha, WI 53144
Phone (262) 652-4006

625 57th St
Ste 700
Kenosha, WI 53140
Phone (262) 656-0044

930 Dr Martin Luther King Dr
#3
Racine, WI 53404
Phone (262) 656-0044

903 S 2nd St
Silver Lake, WI 53170
Phone (262) 656-0044

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Ronald Tatum Individual Corporate Director Feb 26, 2025
John Stampfl Individual Corporate OfficerChief Financial Officer May 19, 2019
Venkata K Thota Individual Corporate Director Feb 26, 2025
Anita Rojas-Johnson Individual Corporate DirectorPresident of Board Feb 26, 2025
Kate Trudell Individual Corporate DirectorVice President of Board Feb 26, 2025
David Geertsen Individual Corporate DirectorTreasurer of Board Feb 26, 2025
Mary E Ouimet Individual Corporate OfficerChief Executive Officer Apr 6, 2020 100%
W-2 Managing EmployeeChief Executive Officer Apr 6, 2020 100%
Erin Ginn Individual Corporate DirectorSecretary of Board Feb 26, 2025
Tony Curtis Moore Individual Corporate Director Feb 26, 2025
Katherine Easthon Individual Corporate Director Feb 26, 2025
Valena Dibbs-Coleman Individual Corporate Director Feb 26, 2025

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 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1750032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771977600000",
    "number": "1215823406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531444819",
            "telephone_number": "262-771-3561",
            "fax_number": "262-764-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 DR MARTIN LUTHER KING DR # 3",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534043008",
            "telephone_number": "262-656-0044",
            "fax_number": "262-764-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KENOSHA COMMUNITY HEALTH CENTER, INC.",
        "enumeration_date": "2025-06-16",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A",
        "authorized_official_last_name": "STAMPFL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "262-771-3561"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100328514",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Racine, WI

Sources for this page

Verify at the official NPI Registry.