NPIMap

Organization Active NPI

Lakeshore Community Health Care, Inc

  • Federally Qualified Health Center (FQHC)
  • Sheboygan, WI
National Provider Identifier
1245520519
Registry record updated Oct 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LAKESHORE COMMUNITY HEALTH CARE, INC
Practice address
510 S. 8TH Street
Sheboygan, WI 53081-4404
Phone
(920) 783-6633
Fax
(920) 783-6392
NPI assigned
Apr 7, 2011
Last updated
Oct 3, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
LAKESHORE COMMUNITY HEALTHCARE, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2014

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

Authorized official

Name
Michele M Schmitt
Title
Office Administrator
Phone
(920) 783-6633

Specialties & licenses 1

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

Addresses

Primary practice location

510 S. 8TH Street
Sheboygan, WI 53081-4404

Mailing address

P.O. Box 959
Sheboygan, WI 53082-0959
Phone (920) 783-6633

Other names 1

  • Sheboygan Area Community Clinics, Inc. Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20121029000074 WI Part A Provider - Federally Qualified Health Center (FQHC) 3173773124 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sheboygan, WI
O20130605000747 WI Part B Supplier - Clinic/Group Practice 3173773124 Receives reassigned benefits from 46 practitioners
5 other NPIs on this enrollment
Practice locations: Manitowoc, WI; Sheboygan, WI; West Bend, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1245520519. Details of each certification follow.

Federally qualified health center certification: CCN 521845

Legal name
LAKESHORE COMMUNITY HEALTH CARE, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 30, 2012
Last certification
Oct 30, 2012
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Jan 27, 2009 in WI
Enrollment address
1721 Saemann Ave
Sheboygan, WI 53081-2342

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Lakeshore Community Health

Locations

510 S 8th St
Sheboygan, WI 53081
Phone (920) 547-5360

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Kristin D Stearns Individual Corporate OfficerCeo Jun 30, 2013
W-2 Managing EmployeeCeo Jun 30, 2013
Operational/Managerial ControlCeo Jun 30, 2013
Lakeshore Community Health Care, Inc Organization, Sheboygan, WI Corporation, Non-profit Operational/Managerial Control Jun 30, 2013
Caleb a Jensema Individual Corporate OfficerCfo Sep 1, 2021
Operational/Managerial ControlCfo Sep 1, 2021

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Lakeshore Community Health Care, IncSheboygan, WI, CCN 521845 Federally qualified health center Operational/Managerial Control Jun 30, 2013

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

NPI Registry JSON

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

{
    "created_epoch": "1302134400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1412294400000",
    "number": "1245520519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 959",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530820959",
            "telephone_number": "920-783-6633",
            "fax_number": "920-783-6392"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 S. 8TH STREET",
            "city": "SHEBOYGAN",
            "state": "WI",
            "postal_code": "530814404",
            "telephone_number": "920-783-6633",
            "fax_number": "920-783-6392"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE COMMUNITY HEALTH CARE, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LAKESHORE COMMUNITY HEALTHCARE, INC",
        "enumeration_date": "2011-04-07",
        "last_updated": "2014-10-03",
        "status": "A",
        "authorized_official_last_name": "SCHMITT",
        "authorized_official_first_name": "MICHELE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OFFICE ADMINISTRATOR",
        "authorized_official_telephone_number": "920-783-6633"
    },
    "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": "Sheboygan Area Community Clinics, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Sheboygan, WI

Sources for this page

Verify at the official NPI Registry.