NPIMap

Organization Active NPI

Kenosha Community Health Center, Inc.

  • Federally Qualified Health Center (FQHC)
  • Kenosha, WI
National Provider Identifier
1265435960
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
NONE Issued in WI
Legal business name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Practice address
4536 22ND Ave
Kenosha, WI 53140-5917
Phone
(262) 656-0044
Fax
(262) 653-2218
NPI assigned
May 27, 2005
Last updated
Feb 25, 2026By the provider in NPPES
Organization subpart
No

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
Mary Elizabeth Ouimet
Title
Ceo
Phone
(262) 771-3561

Specialties & licenses 11

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NONE WI Primary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X NU
Counselor 101Y00000X NU
Mental Health Counselor 101YM0800X NU
Professional Counselor 101YP2500X NU
Clinical Social Worker 1041C0700X NU
Dentist 122300000X NU
Family Medicine Physician 207Q00000X NU
Psychiatry Physician 2084P0800X NU
Child & Adolescent Psychiatry Physician 2084P0804X NU
General Practice Physician 208D00000X NU

Addresses

Primary practice location

4536 22ND Ave
Kenosha, WI 53140-5917

Mailing address

4006 Washington Rd
Kenosha, WI 53144-4819
Phone (262) 656-0044

Other identifiers 1

IdentifierTypeStateIssuer
32956300MedicaidWI

Medicare participation

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

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040217000840 WI Part B Supplier - Clinic/Group Practice 0941195168 Receives reassigned benefits from 26 practitioners
4 other NPIs on this enrollment
Practice locations: Kenosha, WI; Silver Lake, WI
O20090212000224 WI Part A Provider - Federally Qualified Health Center (FQHC) 0941195168 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenosha, WI
O20100921001207 WI Part A Provider - Federally Qualified Health Center (FQHC) 0941195168 Practice locations: Kenosha, WI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1265435960. Details of each certification follow.

Federally qualified health center certification: CCN 521835

Legal name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 15, 2009
Last certification
Apr 15, 2009
Ownership / control type
Non-profit – church related
Organization structure
CorporationProprietary
Incorporated
May 20, 1994 in WI
Enrollment address
6226 14TH Ave
Kenosha, WI 53143-4413

Federally qualified health center certification: CCN 521810

Legal name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 9, 1995
Last certification
Mar 9, 1995
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 20, 1994 in WI
Enrollment address
4536 22ND Ave
Kenosha, WI 53140-5917

Other NPIs with the same Medicare PAC ID 4

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.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0909220Kenosha Community Health Center4536 22ND Ave, Kenosha, WI 53140Certificate of waiverMay 17, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Thomas Smith Individual Corporate Director Jan 1, 2008
Jo Wynn Individual Corporate Director Jan 1, 2008
Pam Halbach Individual Corporate Director Jan 1, 2008
Alan L Marshall Individual Corporate OfficerChief Executive Officer Aug 1, 2017 100%
W-2 Managing EmployeeChief Executive Officer Aug 13, 2018 100%
Mary E Ouimet Individual Corporate OfficerCeo Jun 15, 2022
Corporate OfficerChief Executive Officer Apr 6, 2020 100%
Operational/Managerial ControlChief Executive Officer Apr 6, 2020 100%
Nancy Houtchens Individual Corporate Director Jan 1, 2008
Angela Cunningham Individual Corporate Director Jan 1, 2008

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": "1117152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771977600000",
    "number": "1265435960",
    "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": "262-656-0044",
            "fax_number": "262-764-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4536 22ND AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531405917",
            "telephone_number": "262-656-0044",
            "fax_number": "262-653-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA COMMUNITY HEALTH CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-27",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A",
        "authorized_official_last_name": "OUIMET",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELIZABETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "262-771-3561"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WI",
            "license": "NONE",
            "primary": true
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0804X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32956300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.