NPIMap

Organization Active NPI

The Lakes Community Health Center, Inc

Doing business as NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Augusta, WI
National Provider Identifier
1053155481
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE LAKES COMMUNITY HEALTH CENTER, INC
Doing business as
NorthLakes Community Clinic
Practice address
207 W Lincoln St
Augusta, WI 54722-9161
Phone
(888) 834-4551
NPI assigned
Jun 20, 2024
Last updated
Jun 20, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Authorized official

Name
Rebecca S Rice
Title
Ceo
Phone
(715) 209-8306

Specialties & licenses 1

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

Addresses

Primary practice location

207 W Lincoln St
Augusta, WI 54722-9161

Mailing address

15735 W US Highway 63
Hayward, WI 54843-6475
Phone (888) 834-4551

Other names 1

  • NorthLakes Community 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
O20101019000186 WI Part B Supplier - Clinic/Group Practice 0840366654 Receives reassigned benefits from 119 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: White Lake, WI; Washburn, WI; Turtle Lake, WI; Solon Springs, WI; Eau Claire, WI; Rice Lake, WI; Poplar, WI; Park Falls, WI…
O20241230002610 WI Part A Provider - Federally Qualified Health Center (FQHC) 0840366654 Practice locations: Augusta, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053155481. Details of each certification follow.

Federally qualified health center certification: CCN 521047

Legal name
THE LAKES COMMUNITY HEALTH CENTER INC
Doing business as
NORTHLAKES COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 6, 2024
Last certification
Dec 6, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 14, 2007 in WI
Enrollment address
207 W Lincoln St
Ste 1
Augusta, WI 54722-9162

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
52D2308745Northlakes Community Clinic207 West Lincoln Street, Augusta, WI 54722Certificate of waiverAug 1, 2026

National Provider Directory

National Provider Directory
Tax ID family
The Lakes Community Health Center Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

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
Lisa Kingfisher Individual Corporate DirectorBod Jan 1, 2022
Amy Klebe Individual Corporate DirectorBoard of Directors Jan 1, 2022
Jason Martell Individual Corporate DirectorBod Jan 1, 2022
Joann Fleming Individual Corporate DirectorBoard of Directors Jan 1, 2022
Rebecca S Rice Individual Corporate OfficerCeo Oct 8, 2008
W-2 Managing EmployeeCeo Oct 8, 2008
Nikolai Eliot Individual Corporate DirectorBoard of Directors Jan 1, 2022
Nancy Miller Individual Corporate DirectorBoard of Directors Jan 1, 2022
David Krochalk Individual Corporate DirectorBod Jan 1, 2022
Michael Flaherty Individual Corporate DirectorBoard of Directors Jan 1, 2022
Michael Stamp Individual Corporate DirectorBoard of Directors Jan 1, 2022
Mary Jo Becker Individual Corporate DirectorBoard of Directors Jan 1, 2022

NPI Registry JSON

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

{
    "created_epoch": "1718841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718841600000",
    "number": "1053155481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15735 W US HIGHWAY 63",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436475",
            "telephone_number": "888-834-4551",
            "fax_number": "715-598-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W LINCOLN ST",
            "city": "AUGUSTA",
            "state": "WI",
            "postal_code": "547229161",
            "telephone_number": "888-834-4551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-20",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-209-8306"
    },
    "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": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Augusta, WI

Sources for this page

Verify at the official NPI Registry.