NPIMap

Organization Active NPI

Black River Health Inc

  • Critical Access Hospital
  • Black River Falls, WI
National Provider Identifier
1811940331
Registry record updated Apr 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
1037 Issued in WI
Legal business name
BLACK RIVER HEALTH INC
Practice address
711 W Adams St
Black River Falls, WI 54615-9108
Phone
(715) 284-5361
Fax
(715) 284-1390
NPI assigned
May 18, 2006
Last updated
Apr 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2025

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

Authorized official

Name
Catherine M Bukowski
Title
Cfo
Phone
(715) 284-3661

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 1037 WI Primary

Addresses

Primary practice location

711 W Adams St
Black River Falls, WI 54615-9108

Mailing address

711 W Adams St
Black River Falls, WI 54615-9108
Phone (715) 284-5361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040128000517 WI Part B Supplier - Clinic/Group Practice 3173431178 Receives reassigned benefits from 221 practitioners
4 other NPIs on this enrollment
Practice locations: Black River Falls, WI; Whitehall, WI
O20040303000688 WI Part B Supplier - Clinic/Group Practice 3173431178 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Black River Falls, WI
O20061104000654 WI Part A Provider - Critical Access Hospital 3173431178 Receives reassigned benefits from 167 practitioners
Practice locations: Black River Falls, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811940331. Details of each certification follow.

Hospital certification: CCN 521333

Legal name
BLACK RIVER HEALTH INC
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Feb 5, 2004
Last certification
Feb 5, 2004
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Oct 8, 1965 in WI
Enrollment address
711 W Adams St
Black River Falls, WI 54615-9108
Other Hospital Practice Location

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

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 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
Black River Memorial HospitalCCN 521333 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

311 County Road A
Black River Falls, WI 54615

711 W Adams St
#1
Black River Falls, WI 54615

711 W Adams St
#610
Black River Falls, WI 54615

775 N 8th St
Black River Falls, WI 54615

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Thomas Stuart Walker Individual Corporate DirectorDirector Sep 28, 2021
Timothy Tranberg Individual Corporate DirectorDirector Jun 23, 2022
Michelle Clark-Forsting Individual Corporate DirectorDirector Dec 30, 2024
Katherine Potter Individual Corporate DirectorDirector Jan 1, 2017
Kirk Lane Individual Corporate DirectorDirector Dec 30, 2024
Tammy Hernandez Individual Corporate DirectorVice President Finance Apr 23, 2026
Nicholas Kitowski Individual Corporate DirectorDirector Dec 30, 2024
Timothy F, Kunes Individual Corporate DirectorDirector Jan 1, 2023
Wallace Apland Individual Corporate DirectorTreasurer Dec 19, 2023
Carol a Martin Individual Corporate DirectorDirector Jan 1, 2021
Carl Selvick Individual Corporate DirectorDirector Jun 6, 2022
W-2 Managing Employee Jun 6, 2022

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 251

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 251

Affiliated clinicians 71

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

View all 71

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743724800000",
    "number": "1811940331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1390"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159108",
            "telephone_number": "715-284-5361",
            "fax_number": "715-284-1390"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2025-04-04",
        "certification_date": "2025-04-04",
        "status": "A",
        "authorized_official_last_name": "BUKOWSKI",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "715-284-3661"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "WI",
            "license": "1037",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.