The Lakes Community Health Center, Inc

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

11128 N State Road 77
Hayward, WI 54843-5332

Phone

(715) 634-2541

Fax

(715) 634-5740

NPI assigned

Mar 9, 2006

Last updated

Aug 5, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Reba Rice

Title

Ceo

Phone

(715) 372-5001

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• NorthLakes Community Clinic Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144298787. Details of each certification follow.

• CCN 521841 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 521841

Legal name

NORTH WOODS COMMUNITY HEALTH CENTER

Certification status

Active

Provider type (POS)

Federally qualified health center

Participating since

Dec 5, 2011

Last certification

Dec 5, 2011

Ownership / control type

For profit – corporation

Most recent change of ownership

May 1, 2013 (1 total)

Facility address

11128 N State Highway 77
Hayward, WI 54843

Locations

Practitioners 3

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.

• Sabrina Ann Dunlap, MD

  • Family Medicine Physician
  • Hayward, WI
  • NPI 1083639892
  NPD
• Brent L Kelley, M.D.

  • Family Medicine Physician
  • Hayward, WI
  • NPI 1750306288
  NPD
• Tommy D Nigbor, PA-C

  • Medical Physician Assistant
  • Hayward, WI
  • NPI 1154346518
  NPD

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628121600000",
    "number": "1144298787",
    "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": "715-934-0710",
            "fax_number": "715-598-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11128 N STATE ROAD 77",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548435332",
            "telephone_number": "715-634-2541",
            "fax_number": "715-634-5740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-09",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "REBA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-372-5001"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811178825",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• John Keith Syverson, DDS
• Thomas Erwin Tadysak, DDS
• Savannah Christine Taylor, MSW
• Linda Carol Thatcher, CMT
• The Duluth Clinic, LTD (Essentia Health Hayward Pharmacy)
• The Lakes Community Health Center, Inc
• The Lakes Community Health Center, Inc (NorthLakes Community Clinic)
• Julie Theisen
• Pamela A Thiesing
• James William Toftness, DC

• Federally Qualified Health Center (FQHC) in Hayward, WI
• Providers in Hayward, WI by specialty
• Federally Qualified Health Center (FQHC) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.