Active NPI
Mile Bluff Medical Center Inc
- Emergency Medicine Physician
- Mauston, WI
National Provider Identifier
1609912005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- Legal business name
- MILE BLUFF MEDICAL CENTER INC
- Practice address
- 1050 Division St
Mauston, WI 53948-1931 - Phone
- (608) 847-6161
- Fax
- (608) 847-2079
- NPI assigned
- Jan 30, 2007
- Organization subpart
- Yes
- Parent organization
- MILE BLUFF MEDICAL CENTER INC
NPPES NPI Registry
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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | Primary | ||
| Urgent Care Clinic/Center | 261QU0200X | |||
| Physician Assistant | 363A00000X |
Addresses
Primary practice location
1050 Division St
Mauston, WI 53948-1931
Mailing address
1050 Division St
Mauston, WI 53948-1931
Phone (608) 847-6161
Other practice location 1
406 Gateway Ave
Mauston, WI 53948-1401
Phone (608) 847-2961
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 32762600 | Medicaid | WI |
Other names 1
- Mile Bluff ER/UC Providers
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031205000618 | WI | Part B Supplier - Clinic/Group Practice | 8527971399 |
Receives reassigned benefits from 205 practitioners 2 other NPIs on this enrollment Practice locations: Wisconsin Dells, WI; Tomah, WI; Reedsburg, WI; New Lisbon, WI; Necedah, WI; Mauston, WI; Friendship, WI; Elroy, WI |
Other NPIs with the same Medicare PAC ID 10
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- Rural Health Clinic/Center
- Wisconsin Dells, WI
- NPI 1487734380
8527971399
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Mauston, WI
- NPI 1851438022
8527971399
-
- Certified Registered Nurse Anesthetist
- Mauston, WI
- NPI 1922145077
8527971399
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Rural Health Clinic/Center
- Wisconsin Dells, WI
- NPI 1487734380
O20031205000618
National Provider Directory
National Provider Directory- Part of
- Mile Bluff Medical Ctr Inc
Practitioners & affiliated clinicians
Practitioners 223
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physician Assistant
- Mauston, WI
- NPI 1710978754
-
- Surgical Physician Assistant
- Mauston, WI
- NPI 1932458932
Physician Assistant, WI
-
- Emergency Medicine Physician
- Madison, WI
- NPI 1457649634
Emergency Medicine, WI
-
- Emergency Medicine Physician
- Madison, WI
- NPI 1679739965
Emergency Medicine, WI
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170115200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1775779200000",
"number": "1609912005",
"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": "1050 DIVISION ST",
"city": "MAUSTON",
"state": "WI",
"postal_code": "539481931",
"telephone_number": "608-847-6161",
"fax_number": "608-847-2079"
}
],
"practiceLocations": [
{
"address_1": "406 Gateway Ave",
"address_purpose": "LOCATION",
"city": "Mauston",
"state": "WI",
"postal_code": "539481401",
"country_code": "US",
"telephone_number": "608-847-2961",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "MILE BLUFF MEDICAL CENTER INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MILE BLUFF MEDICAL CENTER INC",
"enumeration_date": "2007-01-30",
"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": "207P00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Emergency Medicine",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QU0200X",
"taxonomy_group": "",
"desc": "Clinic/Center, Urgent Care",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "32762600",
"state": "WI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Mile Bluff ER/UC Providers",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Mile Bluff ER/UC Providers",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Mauston, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.