NPIMap

Organization Active NPI

The Lakes Community Health Center, Inc

  • Federally Qualified Health Center (FQHC)
  • Cumberland, WI
National Provider Identifier
1174247688
Registry record updated Oct 12, 2023
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
Practice address
1150 6TH Ave
Cumberland, WI 54829-9103
Phone
(715) 822-1000
Fax
(715) 822-1001
NPI assigned
Sep 28, 2022
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Rebecca Rice
Title
Ceo
Phone
(715) 372-5001

Specialties & licenses 1

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

Addresses

Primary practice location

1150 6TH Ave
Cumberland, WI 54829-9103

Mailing address

15735 W US Highway 63
Hayward, WI 54843-6475
Phone (715) 934-0710

Other identifiers 1

IdentifierTypeStateIssuer
1811178825MedicaidWI

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…
O20230201000063 WI Part A Provider - Federally Qualified Health Center (FQHC) 0840366654 Practice locations: Cumberland, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174247688. Details of each certification follow.

Federally qualified health center certification: CCN 521006

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
Feb 8, 2023
Last certification
Feb 8, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 14, 2007 in WI
Enrollment address
1110 7TH Ave
Cumberland, WI 54829-9138

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
52D2273941Northlakes Community Clinic1110 7TH Ave, Cumberland, WI 54829Certificate of waiverDec 20, 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 2

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

NameRoleSinceShare
Jane E Snilsberg Individual Corporate DirectorBoard of Directors VP Jan 1, 2010
Rebecca S Rice Individual Corporate OfficerCeo Mar 5, 2009
W-2 Managing EmployeeCeo Mar 5, 2009

NPI Registry JSON

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

{
    "created_epoch": "1664323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1174247688",
    "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": "1150 6TH AVE",
            "city": "CUMBERLAND",
            "state": "WI",
            "postal_code": "548299103",
            "telephone_number": "715-822-1000",
            "fax_number": "715-822-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-28",
        "last_updated": "2023-10-12",
        "certification_date": "2023-09-07",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "REBECCA",
        "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": []
}

Other providers in Cumberland, WI

Sources for this page

Verify at the official NPI Registry.