NPIMap

Organization Active NPI

Mile Bluff Medical Center Inc

Doing business as Mile Bluff Delton Clinic

  • Rural Health Clinic/Center
  • Wisconsin Dells, WI
National Provider Identifier
1487734380
Registry record updated Apr 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MILE BLUFF MEDICAL CENTER INC
Doing business as
Mile Bluff Delton Clinic
Practice address
28 Commerce St
Wisconsin Dells, WI 53965-8293
Phone
(608) 254-5888
NPI assigned
Oct 16, 2006
Last updated
Apr 10, 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 10, 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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X 134 WI
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

28 Commerce St
Wisconsin Dells, WI 53965-8293

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
21271700MedicaidWI

Other names 1

  • Mile Bluff Delton Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031205000618 WI Part B Supplier - Clinic/Group Practice 8527971399 Receives reassigned benefits from 205 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wisconsin Dells, WI; Tomah, WI; Reedsburg, WI; New Lisbon, WI; Necedah, WI; Mauston, WI; Friendship, WI; Elroy, WI
O20230505000519 WI Part A Provider - Rural Health Clinic 8527971399 Practice locations: Wisconsin Dells, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487734380. Details of each certification follow.

Rural health clinic certification: CCN 528653

Legal name
MILE BLUFF MEDICAL CENTER INC
Doing business as
DELTON FAMILY MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 10, 2023
Last certification
Oct 10, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
28 Commerce St
Wisconsin Dells, WI 53965-8293
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).

Other NPIs on the same Medicare enrollment 2

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
52D1020586Delton Family Medical Center28 Commerce St, Wisconsin Dells, WI 53965AccreditationDec 20, 2026

National Provider Directory

National Provider Directory
Part of
Mile Bluff Medical Center Inc

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
Daniel W Kattenbraker Individual Corporate DirectorBoard Chair & MD Feb 1, 2004
James Michael Grannell Individual Corporate DirectorDirector May 1, 2022
Jenna K Sebranek Individual Corporate DirectorDirector & MD Oct 1, 2022
Dara Beth Bartels Individual Corporate OfficerPresident/Ceo Dec 2, 2021
W-2 Managing EmployeeCeo Dec 1, 2021
Operational/Managerial ControlCeo Dec 2, 2021
Larry J Willer Individual Corporate DirectorBoard Treasurer May 1, 2007
Dennis D Loging Individual Corporate DirectorDirector Mar 1, 2016
Cassondra L Kovach Individual Corporate DirectorDirector & MD Jan 1, 2013
W-2 Managing EmployeeDirector & MD Jan 1, 2013
Michael L Pech Individual Corporate DirectorDirector & MD Jul 1, 2022
Randy C Scott Individual Corporate DirectorBoard Vice Chair May 1, 2014
Rebecca Richards-Bria Individual Corporate DirectorDirector Apr 1, 2022
Michelle Herek Individual Corporate DirectorDirector Apr 1, 2022
Lori Murphy Individual Corporate DirectorBoard Secretary Oct 1, 2018

Owners & managing parties with NPI records 5

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

Practitioners & affiliated clinicians

Practitioners 77

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 77

NPI Registry JSON

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1775779200000",
    "number": "1487734380",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 COMMERCE ST",
            "city": "WISCONSIN DELLS",
            "state": "WI",
            "postal_code": "539658293",
            "telephone_number": "608-254-5888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILE BLUFF MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILE BLUFF MEDICAL CENTER INC",
        "enumeration_date": "2006-10-16",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "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": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "WI",
            "license": "134",
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21271700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mile Bluff Delton Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wisconsin Dells, WI

Sources for this page

Verify at the official NPI Registry.