NPIMap

Organization Active NPI

Oconto Hospital & Medical Center Inc

Doing business as Bellin Health Lakewood

  • Rural Health Clinic/Center
  • Lakewood, WI
National Provider Identifier
1790284438
Registry record updated Sep 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
OCONTO HOSPITAL & MEDICAL CENTER INC
Doing business as
Bellin Health Lakewood
Emplify Health Lakewood Clinic
Practice address
15481 Commercial Rd Ste E
Lakewood, WI 54138-9677
Phone
(715) 276-9048
Fax
(920) 445-7289
NPI assigned
Feb 8, 2018
Last updated
Sep 9, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
OCONTO HOSPITAL & MEDICAL CENTER INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 9, 2026

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

Authorized official

Name
Debra Van Pay
Title
Director, Reimbursement
Phone
(920) 436-8628

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

15481 Commercial Rd Ste E
Lakewood, WI 54138-9677

Mailing address

PO Box 1866
Green Bay, WI 54305-1866
Phone (920) 445-7210

Other names 2

  • Bellin Health Lakewood Doing business as
  • Emplify Health Lakewood Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050713000836 WI Part B Supplier - Clinic/Group Practice 2163461781 Receives reassigned benefits from 600 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Three Lakes, WI; West Bend, WI; Suring, WI; Salem, WI; Racine, WI; Peshtigo, WI; Oconto Falls, WI; Marshfield, WI…
O20210415002585 WI Part A Provider - Rural Health Clinic 2163461781 Practice locations: Lakewood, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790284438. Details of each certification follow.

Rural health clinic certification: CCN 528630

Legal name
OCONTO HOSPITAL & MEDICAL CENTER INC
Doing business as
EMPLIFY HEALTH LAKEWOOD CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 5, 2022
Last certification
Jan 5, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 10, 2004 in WI
Enrollment address
15481 Commercial Rd
Ste E
Lakewood, WI 54138-9677
Related CCNs
521356

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

Other NPIs with the same Medicare PAC ID 11

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

Other NPIs on the same Medicare enrollment 8

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
52D2094904Emplify Health Lakewood Clinic15481 Commercial Rd, Suite E, Lakewood, WI 54138Certificate of waiverApr 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Oconto Hospital Med Inc13 organizations share this tax ID, including this one
Part of
Oconto Hospital Med Inc

Other organizations with this tax ID 12

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

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 Jan 1, 2025
Scott Rathgaber Individual Corporate Officer Dec 1, 2022
Oconto Hospital & Medical Center Inc Organization, Oconto, WI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2022 100%
Debra Van Pay Individual Corporate DirectorDirector May 1, 2026
W-2 Managing EmployeeDirector May 1, 2026
Sharla Baenen Individual Corporate Officer Oct 1, 2022
Sara L Arndt Individual Corporate Director Apr 1, 2021
W-2 Managing Employee Apr 1, 2021
Bellin Gundersen Health System Inc Organization, La Crosse, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Dec 1, 2022
Bellin Health Systems, Inc. Organization, Green Bay, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2022
Heather Schimmers Individual Corporate Director May 1, 2026
Laura a Hieb Individual Corporate Director Apr 1, 2021
Peter Vandenhouten Individual Corporate Director Jan 1, 2025
Bellin Memorial Hospital Inc Organization, Green Bay, WI Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Jan 1, 2022

Owners & managing parties with NPI records 23

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

View all 23

All facility ownership & control disclosures 8

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

FacilityTypeRoleSince
Emplify Health Oconto ClinicOconto, WI, CCN 528554 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jun 1, 2021
Emplify Health Peshtigo ClinicPeshtigo, WI, CCN 528580 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 14, 2016
Emplify Health Crivitz ClinicCrivitz, WI, CCN 528579 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 14, 2016
Emplify Health Menominee ClinicMenominee, MI, CCN 238705 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 14, 2016
Emplify Health Daggett ClinicDaggett, MI, CCN 238704 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 14, 2016
Emplify Health Marinette ClinicMarinette, WI, CCN 528578 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Nov 14, 2016
Emplify Health Oconto Falls ClinicOconto Falls, WI, CCN 528617 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Oct 1, 2020
Emplify Health Suring ClinicSuring, WI, CCN 528631 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2022

Owned or controlled facilities with NPI records 8

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

Facilities with the same owner 51

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

View all 51

Practitioners & affiliated clinicians

Practitioners 64

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 64

NPI Registry JSON

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

{
    "created_epoch": "1518048000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788912000000",
    "number": "1790284438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051866",
            "telephone_number": "920-445-7210",
            "fax_number": "920-445-7289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15481 COMMERCIAL RD STE E",
            "city": "LAKEWOOD",
            "state": "WI",
            "postal_code": "541389677",
            "telephone_number": "715-276-9048",
            "fax_number": "920-445-7289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OCONTO HOSPITAL & MEDICAL CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OCONTO HOSPITAL & MEDICAL CENTER INC",
        "enumeration_date": "2018-02-08",
        "last_updated": "2026-09-09",
        "certification_date": "2026-09-09",
        "status": "A",
        "authorized_official_last_name": "VAN PAY",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "DIRECTOR, REIMBURSEMENT",
        "authorized_official_telephone_number": "920-436-8628"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bellin Health Lakewood",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emplify Health Lakewood Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakewood, WI

Sources for this page

Verify at the official NPI Registry.