NPIMap

Organization Active NPI

Oakleaf Clinics Inc

Doing business as Oakleaf Clinics, Southside Medical Clinic

  • Internal Medicine Physician
  • Eau Claire, WI
National Provider Identifier
1306238191
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
OAKLEAF CLINICS INC
Doing business as
Oakleaf Clinics, Southside Medical Clinic
Practice address
714 W Hamilton Ave
Eau Claire, WI 54701-6937
Phone
(715) 830-9990
Fax
(715) 830-9995
NPI assigned
Mar 3, 2015
Last updated
Sep 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
OAKLEAF CLINICS SCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Authorized official

Name
Dr. Chris R Longbella, MDNPI 1992804413
Title
Director
Phone
(715) 836-9242

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

714 W Hamilton Ave
Eau Claire, WI 54701-6937

Mailing address

719 W Hamilton Ave Ste B
Eau Claire, WI 54701-6970
Phone (715) 552-9784

Other names 1

  • Oakleaf Clinics, Southside Medical Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110602000195 WI Part B Supplier - Clinic/Group Practice 4486831328 Receives reassigned benefits from 120 practitioners
15 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Rice Lake, WI; Menomonie, WI; Ladysmith, WI; Eau Claire, WI; Cornell, WI; Chippewa Falls, WI; Altoona, WI

Other NPIs on the same Medicare enrollment 15

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

View all 15

National Provider Directory

National Provider Directory
Tax ID family
Oakleaf Clinics Inc5 organizations share this tax ID, including this one
Part of
Oakleaf Clinics Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

714 W Hamilton Ave
Eau Claire, WI 54701
Phone (715) 830-9990

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663718400000",
    "number": "1306238191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "719 W HAMILTON AVE STE B",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016970",
            "telephone_number": "715-552-9784",
            "fax_number": "715-835-6370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "714 W HAMILTON AVE",
            "city": "EAU CLAIRE",
            "state": "WI",
            "postal_code": "547016937",
            "telephone_number": "715-830-9990",
            "fax_number": "715-830-9995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OAKLEAF CLINICS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "OAKLEAF CLINICS SC",
        "enumeration_date": "2015-03-03",
        "last_updated": "2022-09-21",
        "certification_date": "2022-08-31",
        "status": "A",
        "authorized_official_last_name": "LONGBELLA",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "715-836-9242",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oakleaf Clinics, Southside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Oakleaf Clinics, Southside Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eau Claire, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.