NPIMap

Organization Active NPI

Mile Bluff Medical Center Inc

Doing business as Mile Bluff Necedah Clinic

  • Rural Health Clinic/Center
  • Necedah, WI
National Provider Identifier
1447397492
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 Necedah Clinic
Practice address
1408 Wheelihan Ave
Necedah, WI 54646-8253
Phone
(608) 847-6161
Fax
(608) 847-6161
NPI assigned
Jan 31, 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

1408 Wheelihan Ave
Necedah, WI 54646-8253

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
43054600MedicaidWI

Other names 1

  • Mile Bluff Necedah Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080702000586 WI Part A Provider - Rural Health Clinic 8527971399 Practice locations: Necedah, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447397492. Details of each certification follow.

Rural health clinic certification: CCN 523990

Legal name
MILE BLUFF MEDICAL CENTER INC
Doing business as
NECEDAH FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 21, 1995
Last certification
Jan 6, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1962 in WI
Enrollment address
1408 Wheelihan Avenue
Necedah, WI 54646-8253
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).

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
52D0896236Necedah Family Medical Center1408 Wheelihan Ave, Necedah, WI 54646AccreditationOct 30, 2027

National Provider Directory

National Provider Directory
Part of
Hess Memorial Hospital

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
Daniel W Kattenbraker Individual Corporate Director Feb 1, 2010
W-2 Managing Employee Jan 1, 2013
Brian S Schultz Individual Corporate DirectorMD/Board Member Mar 1, 2021
Dara Beth Bartels Individual Corporate OfficerPresident/Ceo Dec 2, 2021
W-2 Managing EmployeeCeo Dec 2, 2021 100%
Operational/Managerial ControlCeo Dec 2, 2021 100%
Larry J Willer Individual Corporate Director May 1, 2007
Dennis D Loging Individual Corporate DirectorBoard Member Mar 1, 2016
Cassondra L Kovach Individual Corporate DirectorMD Jan 1, 2013
W-2 Managing EmployeeMD Jan 1, 2013
Sandy R Linsmeyer Individual Corporate Director Dec 1, 2004
Randy C Scott Individual Corporate Director Jan 1, 2015
Rebecca Richards-Bria Individual Corporate DirectorBoard Member Apr 1, 2022
Michelle Herek Individual Corporate DirectorBoard Member Apr 1, 2022
Lori Murphy Individual Corporate DirectorBoard Member Oct 1, 2018

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": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776038400000",
    "number": "1447397492",
    "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": "608-847-6161"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1408 WHEELIHAN AVE",
            "city": "NECEDAH",
            "state": "WI",
            "postal_code": "546468253",
            "telephone_number": "608-847-6161",
            "fax_number": "608-847-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE BLUFF MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILE BLUFF MEDICAL CENTER INC",
        "enumeration_date": "2007-01-31",
        "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": "43054600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Bluff Necedah Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Necedah, WI

Sources for this page

Verify at the official NPI Registry.