NPIMap

Organization Active NPI

Burnett Medical Center Inc

Doing business as Burnett Medical Center

  • Rural Health Clinic/Center
  • Grantsburg, WI
National Provider Identifier
1356499784
Registry record updated Oct 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BURNETT MEDICAL CENTER INC
Doing business as
Burnett Medical Center
Practice address
257 W Saint George Ave
Grantsburg, WI 54840-7827
Phone
(715) 463-5353
NPI assigned
Jan 8, 2007
Last updated
Oct 10, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BURNETT MEDICAL CENTER INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 10, 2024

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

Authorized official

Name
Tamra White
Title
Medical Practice Administrator
Phone
(715) 463-7210

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Physician Assistant 363A00000X 1034 WI
Nurse Practitioner 363L00000X 1034 WI
Advanced Practice Midwife 367A00000X 1034 WI
Family Medicine Physician 207Q00000X 1034 WI

Addresses

Primary practice location

257 W Saint George Ave
Grantsburg, WI 54840-7827

Mailing address

257 W Saint George Ave
Grantsburg, WI 54840-7827
Phone (715) 463-5317

Other identifiers 4

IdentifierTypeStateIssuer
124768MedicaidMN
001212MedicaidWI
526247000MedicaidMN
110166100MedicaidWI

Other names 1

  • Burnett Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040326000457 WI Part B Supplier - Clinic/Group Practice 2163314931 Receives reassigned benefits from 82 practitioners
Practice locations: Grantsburg, WI
O20081027000722 WI Part A Provider - Rural Health Clinic 2163314931 Practice locations: Grantsburg, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356499784. Details of each certification follow.

Rural health clinic certification: CCN 528517

Legal name
BURNETT MEDICAL CENTER INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 6, 2002
Last certification
Aug 3, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Nov 30, 1956 in WI
Enrollment address
257 W Saint George Ave
Grantsburg, WI 54840-7827
Related CCNs
521331

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

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Part of
Burnett Medical Center

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Bremer Bank, National Association Organization, Amery, WI Financial institution 5% Or Greater Mortgage Interest Mar 23, 2007 63%
Stuart McIntosh Individual Corporate Director Jan 16, 2024 11%
Tamra J White Individual Corporate OfficerChief Administrative Officer Jun 26, 2025 11%
Kenneth Kutz Individual Corporate OfficerBoard President Jan 21, 2025 11%
David Dahlberg Individual Corporate Director Jan 21, 2025 11%
Julie M McKenzie Individual W-2 Managing EmployeeHuman Resources Director Feb 9, 2024
Tanya Jensen Individual Corporate Director Jan 21, 2025 11%
Jennifer a Hoefs Individual W-2 Managing EmployeePatient Care Coordinator & PR Feb 9, 2024
Lois E Carlson Individual Corporate Director Jan 21, 2020 11%
Mark L Thayer Individual Corporate DirectorBoard Member Jan 21, 2025 12%
W-2 Managing Employee May 15, 2025
Taylor J Paap Individual Corporate Director Jan 17, 2023 11%
Megan Sandgren Individual Corporate OfficerChief Executive Officer Dec 1, 2025 11%
W-2 Managing EmployeeAd; Dec 1, 2025

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 93

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 93

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728518400000",
    "number": "1356499784",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "257 W SAINT GEORGE AVE",
            "city": "GRANTSBURG",
            "state": "WI",
            "postal_code": "548407827",
            "telephone_number": "715-463-5353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BURNETT MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BURNETT MEDICAL CENTER INC.",
        "enumeration_date": "2007-01-08",
        "last_updated": "2024-10-10",
        "certification_date": "2024-10-10",
        "status": "A",
        "authorized_official_last_name": "WHITE",
        "authorized_official_first_name": "TAMRA",
        "authorized_official_title_or_position": "MEDICAL PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "715-463-7210"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WI",
            "license": "1034",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "1034",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "WI",
            "license": "1034",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "1034",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "124768",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001212",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526247000",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110166100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Burnett Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grantsburg, WI

Sources for this page

Verify at the official NPI Registry.