NPIMap

Organization Active NPI

Kenosha Community Health Center, Inc

Doing business as Pillar Health

  • Federally Qualified Health Center (FQHC)
  • Kenosha, WI
National Provider Identifier
1710635677
Registry record updated Feb 25, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
KENOSHA COMMUNITY HEALTH CENTER, INC
Doing business as
Pillar Health
Practice address
4006 Washington Rd
Kenosha, WI 53144-4819
Phone
(262) 656-0044
NPI assigned
Mar 10, 2022
Last updated
Feb 25, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2026

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

Authorized official

Name
Mr. John William Stampfl
Title
Controller
Phone
(262) 656-0044

Specialties & licenses 1

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

Addresses

Primary practice location

4006 Washington Rd
Kenosha, WI 53144-4819

Mailing address

4006 Washington Rd
Kenosha, WI 53144-4819
Phone (262) 656-0044

Other names 1

  • Pillar Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040217000840 WI Part B Supplier - Clinic/Group Practice 0941195168 Receives reassigned benefits from 26 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kenosha, WI; Silver Lake, WI
O20220511000247 WI Part A Provider - Federally Qualified Health Center (FQHC) 0941195168 Practice locations: Kenosha, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710635677. Details of each certification follow.

Federally qualified health center certification: CCN 521002

Legal name
KENOSHA COMMUNITY HEALTH CENTER, INC.
Doing business as
PILLAR HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 3, 2023
Last certification
Jan 3, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 3, 2022 in WI
Enrollment address
4006 Washington Rd
Kenosha, WI 53144-4819

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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
52D2259362Kenosha Community Health Center, Inc4006 Washington Rd, Kenosha, WI 53144Certificate of waiverFeb 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Kenosha Comm Health Ctr4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

4536 22nd Ave
Kenosha, WI 53140
Phone (262) 656-0044

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Gary R Moss Individual Corporate OfficerCfo Jun 24, 2019
Mary E Ouimet Individual Corporate OfficerCeo Jun 15, 2020
W-2 Managing EmployeeCeo Jun 15, 2020
Joseph Clark Individual Corporate OfficerBoard Treasurer Mar 1, 2018
Paul G Spottswood Individual Corporate OfficerBoard Member Nov 1, 2018

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1646870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1771977600000",
    "number": "1710635677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4006 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531444819",
            "telephone_number": "262-656-0044",
            "fax_number": "262-764-3636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4006 WASHINGTON RD",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531444819",
            "telephone_number": "262-656-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-10",
        "last_updated": "2026-02-25",
        "certification_date": "2026-02-25",
        "status": "A",
        "authorized_official_last_name": "STAMPFL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "262-656-0044",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pillar Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.