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The Lakes Community Health Center, Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Augusta, WI

NPI 1053155481 · NPPES record last updated Jun 20, 2024

Key facts

NPI
1053155481
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
THE LAKES COMMUNITY HEALTH CENTER, INC
Practice address
207 W Lincoln St
Augusta, WI 54722-9161
Phone
(888) 834-4551
NPI assigned
Jun 20, 2024
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 17

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

Other NPIs with the same Medicare PAC ID 12

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

Corporate family (same tax ID) 19

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

Practitioners 104

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 104

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D2308745Northlakes Community Clinic
207 West Lincoln Street, Augusta, WI 54722		Certificate of waiverAug 1, 2026

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in WI

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
Corporation · Non-profit
Incorporated
May 14, 2007 in WI
Enrollment address
207 W Lincoln St
Ste 1
Augusta, WI 54722-9162

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 Director
Bod		 Jan 1, 2022
Amy Klebe
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
Jason Martell
Individual 		Corporate Director
Bod		 Jan 1, 2022
Joann Fleming
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
Rebecca S Rice
Individual 		Corporate Officer
Ceo		 Oct 8, 2008
W-2 Managing Employee
Ceo		 Oct 8, 2008
Nikolai Eliot
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
Nancy Miller
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
David Krochalk
Individual 		Corporate Director
Bod		 Jan 1, 2022
Michael Flaherty
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
Michael Stamp
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022
Mary Jo Becker
Individual 		Corporate Director
Board of Directors		 Jan 1, 2022

Medicare enrollment records

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

National Provider Directory

Tax ID family
The Lakes Community Health Center Inc (20 organizations share this tax ID)

Specialties & licenses

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

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

  • NorthLakes Community Clinic Doing business as

Other providers in Augusta, WI

All providers in Augusta, WI · Federally Qualified Health Center (FQHC) in Wisconsin

Sources for this page

Verify at the official NPI Registry.