NPIMap

Individual provider Active NPI

Michelle J Clark-Forsting, MD

  • Family Medicine Physician
  • Black River Falls, WI
National Provider Identifier
1093073975
Registry record updated Jun 30, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
61498-20 Issued in WI
Practice address
610 W Adams St
Black River Falls, WI 54615-9010
Phone
(715) 284-4311
NPI assigned
Apr 27, 2012
Last updated
Jun 30, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X WI
Family Medicine Physician 207Q00000X 61498-20 WI Primary

Addresses

Primary practice location

610 W Adams St
Black River Falls, WI 54615-9010

Mailing address

610 W Adams St
Black River Falls, WI 54615-9010
Phone (715) 284-4311

Other practice location 1

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150127000483 WI Practitioner - Family Practice 1759605504 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Wisconsin School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Black River Health IncGroup PAC ID 3173431178, 62 clinicians

Practice addresses (Care Compare)

711 W Adams St
Black River Falls, WI 54615-5052
Phone (715) 284-5361

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

724 Rose St
Black River Falls, WI 54615-9278

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
89.18 of 100Reported as group
Quality
87.29
Promoting interoperability
100
Improvement activities
40
Cost
65.34

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
61498-20WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Black River Health Inc CurrentSince Dec 1, 2014 Accepting new patients
Black River Health Inc CurrentSince Dec 1, 2014 Accepting new patients
Krohn Clinic LTD. Family Medicine CurrentSince Nov 1, 2015 Accepting new patients
Black River Health Inc Current Accepting new patients

Locations

610 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-4311

711 W Adams St
Blk River Fls, WI 54615
Phone (715) 284-3604

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BHJBDA
  • Direct secure messaging: michelle.forsting@kcld.eclinicaldirectplus.com

Ownership & related parties

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Black River Health IncBlack River Falls, WI, CCN 521333 Hospital Corporate Director Dec 30, 2024
Black River Health IncBlack River Falls, WI, CCN 52Z333 Hospital Corporate Director Dec 30, 2024
Krohn ClinicBlack River Falls, WI, CCN 528643 Rural health clinic Corporate Director Dec 30, 2024
Black River Healthcare ClinicBlack River Falls, WI, CCN 528658 Rural health clinic Corporate Director Dec 30, 2024

Owned or controlled facilities with NPI records 4

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

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1335484800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751241600000",
    "number": "1093073975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 W ADAMS ST",
            "city": "BLACK RIVER FALLS",
            "state": "WI",
            "postal_code": "546159010",
            "telephone_number": "715-284-4311"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 W Adams St",
            "address_purpose": "LOCATION",
            "city": "Black River Falls",
            "state": "WI",
            "postal_code": "546155052",
            "country_code": "US",
            "telephone_number": "715-284-5361",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CLARK-FORSTING",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-27",
        "last_updated": "2025-06-30",
        "certification_date": "2025-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "61498-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Black River Falls, WI

Sources for this page

Verify at the official NPI Registry.