NPIMap

Organization Active NPI

Mayo Clinic Health System-Northwest Wisconsin Region, Inc.

Doing business as Mayo Clinic Health System-Bloomer

  • Medicare Defined Swing Bed Hospital Unit
  • Bloomer, WI
National Provider Identifier
1639109176
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
1017 Issued in WI
Legal business name
MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC.
Doing business as
Mayo Clinic Health System-Bloomer
Mayo Clinic Health System-Chippewa Valley, Inc.
Practice address
1501 Thompson St
Bloomer, WI 54724-1257
Phone
(715) 568-2000
NPI assigned
Jul 3, 2006
Last updated
Aug 11, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Authorized official

Name
Adam Smith
Title
Cfo
Phone
(715) 838-5275

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 1017 WI Primary

Addresses

Primary practice location

1501 Thompson St
Bloomer, WI 54724-1257

Mailing address

1501 Thompson St
Bloomer, WI 54724-1257
Phone (715) 568-2000

Other identifiers 1

IdentifierTypeStateIssuer
11018500MedicaidWI

Other names 2

  • Mayo Clinic Health System-Bloomer Doing business as
  • Mayo Clinic Health System-Chippewa Valley, Inc. Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Ability Network

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171205000025 WI Part A Provider - Critical Access Hospital 4385553627 Practice locations: Bloomer, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639109176. Details of each certification follow.

Hospital certification: CCN 52Z314

Legal name
MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION INC
Doing business as
MAYO CLINIC HEALTH SYSTEM-CHIPPEWA VALLEY
Organization structure
CorporationNon-profit
Incorporated
May 11, 1905 in WI
Enrollment address
1501 Thompson St
Bloomer, WI 54724-1257

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

Other NPIs with the same Medicare PAC ID 20

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

View all 20

National Provider Directory

National Provider Directory
Tax ID family
Luther Hospital25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Matthew J Olmstead Individual Corporate DirectorBoard Member Jan 1, 2025
Paul Molling Individual Corporate OfficerVice Chair Mar 11, 2026
Corporate DirectorBoard Member Mar 11, 2026
Franklin K Ackerman Individual Corporate OfficerSecretary Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2025
Jason Beckermann Individual Corporate DirectorBoard Member Jan 1, 2025
Dean B Eide Individual W-2 Managing EmployeeVice Chair Administration Oct 1, 2021
Timothy J Young Individual Corporate DirectorBoard Member Jan 1, 2025
Richard a Helmers Individual Corporate OfficerCeo & Chair Jan 1, 2018
Corporate DirectorBoard Member Jan 1, 2018
Lisa Gillette Individual Corporate DirectorBoard Member May 1, 2026
Charles W Nordstrom Individual Corporate DirectorBoard Member Jan 1, 2025
Kevin M Fitzgerald Individual Corporate DirectorBoard Member Jan 1, 2025
Gurpreet Singh Individual Corporate DirectorBoard Member Jan 1, 2025
Robert J Wiechmann Individual Corporate DirectorBoard Member Jan 1, 2025
Mayo Clinic Organization, Rochester, MN Corporation, Non-profit, Chain home office Operational/Managerial Control Jan 1, 2018
Adam W Smith Individual Corporate OfficerCfo & Treasurer Jan 19, 2026
Corporate DirectorBoard Member Jan 19, 2026
Kelly M Buchholtz Individual Corporate DirectorBoard Member Jan 1, 2025
Janel N Glantz Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 16

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

View all 16

Facilities with the same owner 38

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 38

Practitioners & affiliated clinicians

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1786406400000",
    "number": "1639109176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 THOMPSON ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241257",
            "telephone_number": "715-568-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 THOMPSON ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241257",
            "telephone_number": "715-568-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAYO CLINIC HEALTH SYSTEM-NORTHWEST WISCONSIN REGION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-03",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ADAM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-838-5275"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "WI",
            "license": "1017",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11018500",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd SteB",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Mayo Clinic Health System-Bloomer",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mayo Clinic Health System-Chippewa Valley, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomer, WI

Sources for this page

Verify at the official NPI Registry.