NPIMap

Organization Active NPI

Stockbridge Munsee Community

Doing business as Stockbridge Munsee Health & Wellness Ctr

  • Federally Qualified Health Center (FQHC)
  • Bowler, WI
National Provider Identifier
1629070180
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
STOCKBRIDGE MUNSEE COMMUNITY
Doing business as
Stockbridge Munsee Health & Wellness Ctr
Practice address
W12802 Cty Rd a
Bowler, WI 54416
Phone
(715) 793-4144
Fax
(715) 793-5028
NPI assigned
Aug 15, 2005
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

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

Authorized official

Name
Mr. Wallace A. Miller
Title
Tribal Chairman
Phone
(715) 793-4111

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

W12802 Cty Rd a
Bowler, WI 54416

Mailing address

P.O. Box 70
W12802 Cty Rd a
Bowler, WI 54416
Phone (715) 793-4144

Other identifiers 5

IdentifierTypeStateIssuer
41730300MedicaidWI
42125400MedicaidWI
32955900MedicaidWI
39114544+040OtherWIBLUE CROSS BLUE SHIELD
44008700MedicaidWI

Other names 1

  • Stockbridge Munsee Health & Wellness Ctr Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031204000904 WI Part B Supplier - Clinic/Group Practice 9830094655 Receives reassigned benefits from 12 practitioners
Practice locations: Bowler, WI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 12

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": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1629070180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 70",
            "address_2": "W12802 CTY RD A",
            "city": "BOWLER",
            "state": "WI",
            "postal_code": "54416",
            "telephone_number": "715-793-4144",
            "fax_number": "715-793-5028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W12802 CTY RD A",
            "city": "BOWLER",
            "state": "WI",
            "postal_code": "54416",
            "telephone_number": "715-793-4144",
            "fax_number": "715-793-5028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STOCKBRIDGE MUNSEE COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "TRIBAL CHAIRMAN",
        "authorized_official_telephone_number": "715-793-4111",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41730300",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42125400",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32955900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "39114544+040",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44008700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Stockbridge Munsee Health & Wellness Ctr",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bowler, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; 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.

Verify at the official NPI Registry.