High Point Family Medicine, LLC
Organization Active NPI Family Medicine Physician · Fennimore, WI
NPI 1285826313 · NPPES record last updated Jan 8, 2024
Key facts
- NPI
- 1285826313
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- HIGH POINT FAMILY MEDICINE, LLC
- Practice address
- 1525 Lafollette St
Fennimore, WI 53809 - Phone
- (608) 822-3363
- Fax
- (866) 560-8783
- NPI assigned
- Aug 13, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Eric E Stader, M.D.
- Title
- President
- Phone
- (608) 723-3100
Other NPIs on the same Medicare enrollment 1
Practitioners 6
-
Ashley Luecke, PA-C
-
Neil T Martin, MD
-
Eric G Slane, MD
-
Eric E Stader, MD
-
Jessica H Varnam, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D1072777 | High Point Family Medicine LLC | Certificate of waiver | Aug 22, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071020000025 | WI | Part B Supplier - Clinic/Group Practice | 0446346514 |
Receives reassigned benefits from 8 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Fennimore, WI; Lancaster, WI |
National Provider Directory
Locations
1255 11th St
Fennimore, WI 53809
105 E Lincoln Ave
Lancaster, WI 53813
Phone (608) 723-3100
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1525 Lafollette St
Fennimore, WI 53809
Mailing address
1525 Lafollette St
Fennimore, WI 53809
Phone (608) 822-3363
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 21313200 | Medicaid | WI |
Other providers in Fennimore, WI
- Grant Regional Health Center, Inc
- GTN Fennimore, Inc.
- Jacqueline Hanson
- Hartig Drug Co Corp
- Amanda Lee Haugrud
- Nicole M Kaiser
- Lori Lynn Kartman
- Kaitlin Kersten
- Rita M. Lease
- Zhenyu Liang
All providers in Fennimore, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 8, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.