NPIMap

Organization Active NPI

Bellin Memorial Hospital Inc

Doing business as FMC Kewaunee

  • Rural Health Clinic/Center
  • Kewaunee, WI
National Provider Identifier
1699737379
Registry record updated Jul 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BELLIN MEMORIAL HOSPITAL INC
Doing business as
FMC Kewaunee
Practice address
575 4TH St
Kewaunee, WI 54216-1785
Phone
(920) 388-4640
NPI assigned
Apr 6, 2006
Last updated
Jul 28, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
BELLIN MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 28, 2025

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

Authorized official

Name
Abby Julia Engebose
Title
Credentialing Specialist
Phone
(920) 433-7860

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

575 4TH St
Kewaunee, WI 54216-1785

Mailing address

575 4TH St
Kewaunee, WI 54216-1785
Phone (920) 388-4640

Other names 1

  • FMC KEWAUNEE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031121000089 WI Part B Supplier - Clinic/Group Practice 8820900749 Receives reassigned benefits from 936 practitioners
This NPI is an additional NPI on the enrollment
O20050909000116 WI Part A Provider - Rural Health Clinic 8820900749 Practice locations: Kewaunee, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699737379. Details of each certification follow.

Rural health clinic certification: CCN 523864

Legal name
BELLIN MEMORIAL HOSPITAL INC
Doing business as
FMC KEWAUNEE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2001
Last certification
Sep 10, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 3, 1934 in WI
Enrollment address
575 4TH St
Kewaunee, WI 54216-1785

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Part of
Bellin Memorial Hospita

Locations

2714 Riverview Dr
Green Bay, WI 54313
Phone (920) 430-4760

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Michael Landrum Individual Corporate Director Dec 1, 2025
Scott Rathgaber Individual Corporate Director Oct 1, 2022
Debra Van Pay Individual Corporate DirectorDirector Dec 1, 2025
W-2 Managing EmployeeDirector Dec 1, 2025
Sharla Baenen Individual Corporate Director Oct 1, 2022
Sara L Arndt Individual W-2 Managing EmployeeTeam Leader Accounting Oct 1, 2022
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation 5% Or Greater Indirect Ownership Interest Dec 1, 2022
Bellin Health Systems, Inc. Organization, Green Bay, WI Corporation 5% Or Greater Direct Ownership Interest Oct 1, 2022
Laura a Hieb Individual Corporate Director Oct 1, 2022
Peter Vandenhouten Individual Corporate Director Oct 1, 2022

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 12

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Emplify Health Oconto ClinicOconto, WI, CCN 521356 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
Emplify Health Oconto HospitalOconto, WI, CCN 52Z356 Hospital 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
UnityDe Pere, WI, CCN 521503 Hospice 5% Or Greater Direct Ownership Interest (45%)
Limited Partnership Interest (45%)
Operational/Managerial Control (45%)		 Oct 1, 1992
Oct 1, 1992
Oct 1, 1992
Emplify Health Oconto ClinicOconto, WI, CCN 528554 Rural health clinic 5% Or Greater Indirect Ownership Interest Jun 1, 2021
Emplify Health Peshtigo ClinicPeshtigo, WI, CCN 528580 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Crivitz ClinicCrivitz, WI, CCN 528579 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Menominee ClinicMenominee, MI, CCN 238705 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Daggett ClinicDaggett, MI, CCN 238704 Rural health clinic 5% Or Greater Indirect Ownership Interest Nov 14, 2016
Emplify Health Marinette ClinicMarinette, WI, CCN 528578 Rural health clinic 5% Or Greater Indirect Ownership Interest Oct 14, 2016
Emplify Health Oconto Falls ClinicOconto Falls, WI, CCN 528617 Rural health clinic 5% Or Greater Indirect Ownership Interest Oct 1, 2020
Emplify Health Lakewood ClinicLakewood, WI, CCN 528630 Rural health clinic 5% Or Greater Indirect Ownership Interest Jan 1, 2022
Emplify Health Suring ClinicSuring, WI, CCN 528631 Rural health clinic 5% Or Greater Indirect Ownership Interest Jan 19, 2022

Owned or controlled facilities with NPI records 12

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 50

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

View all 50

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1699737379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 4TH ST",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161785",
            "telephone_number": "920-388-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 4TH ST",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161785",
            "telephone_number": "920-388-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BELLIN MEMORIAL HOSPITAL INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BELLIN MEMORIAL HOSPITAL INC",
        "enumeration_date": "2006-04-06",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "ENGEBOSE",
        "authorized_official_first_name": "ABBY",
        "authorized_official_middle_name": "JULIA",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "920-433-7860"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FMC KEWAUNEE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "FMC KEWAUNEE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kewaunee, WI

Sources for this page

Verify at the official NPI Registry.