NPIMap

Organization Active NPI

Mile Bluff Medical Center Inc

Doing business as Mile Bluff Elroy Clinic

  • Rural Health Clinic/Center
  • Elroy, WI
National Provider Identifier
1285770016
Registry record updated Apr 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
134 Issued in WI
Legal business name
MILE BLUFF MEDICAL CENTER INC
Doing business as
Mile Bluff Elroy Clinic
Practice address
1515 Academy St
Elroy, WI 53929-1011
Phone
(608) 847-6161
Fax
(608) 847-2079
NPI assigned
Jan 29, 2007
Last updated
Apr 13, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MILE BLUFF MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 13, 2026

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

Authorized official

Name
Thomas Kaminski
Title
VP/Cfo
Phone
(608) 847-1452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 134 WI Primary

Addresses

Primary practice location

1515 Academy St
Elroy, WI 53929-1011

Mailing address

1050 Division St
Mauston, WI 53948-1931
Phone (608) 847-6161

Other identifiers 1

IdentifierTypeStateIssuer
43052700MedicaidWI

Other names 1

  • Mile Bluff Elroy Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100506000436 WI Part A Provider - Rural Health Clinic 8527971399 Practice locations: Elroy, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285770016. Details of each certification follow.

Rural health clinic certification: CCN 523984

Legal name
MILE BLUFF MEDICAL CENTER INC
Doing business as
MILE BLUFF ELROY CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 1, 1993
Last certification
Apr 19, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 4, 1962 in WI
Enrollment address
1515 Academy St
Elroy, WI 53929-1011
Related CCNs
520109

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

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Part of
Hess Memorial Hospital

Locations

28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888

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
Melanie Gray Individual Corporate OfficerBoard Member Jan 1, 2026
James Michael Grannell Individual Corporate OfficerBoard Member Jan 1, 2026
Jenna K Sebranek Individual Corporate OfficerBoard Member Jan 1, 2026
Joseph Lee Witmer Individual Corporate OfficerBoard Member Jan 1, 2026
Jordan Schmidt Individual Corporate OfficerBoard Member Jan 1, 2026
Dara Beth Bartels Individual Corporate DirectorCeo Dec 1, 2021
W-2 Managing EmployeeCeo Dec 1, 2021
Ryan a Plamann Individual Corporate OfficerBoard Member Jan 1, 2026
Dennis D Loging Individual Corporate OfficerBoard Member Mar 1, 2016
Randy C Scott Individual Corporate OfficerBoard Member May 1, 2013
Kevin Quist Individual Corporate OfficerBoard Member Jan 1, 2026

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1285770016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481931",
            "telephone_number": "608-847-6161",
            "fax_number": "608-847-2079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 ACADEMY ST",
            "city": "ELROY",
            "state": "WI",
            "postal_code": "539291011",
            "telephone_number": "608-847-6161",
            "fax_number": "608-847-2079"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE BLUFF MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILE BLUFF MEDICAL CENTER INC",
        "enumeration_date": "2007-01-29",
        "last_updated": "2026-04-13",
        "certification_date": "2026-04-13",
        "status": "A",
        "authorized_official_last_name": "KAMINSKI",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "608-847-1452"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "WI",
            "license": "134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43052700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Bluff Elroy Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elroy, WI

Sources for this page

Verify at the official NPI Registry.