NPIMap

Organization Active NPI

Consultants Laboratory of Wisconsin, LLC

Doing business as SSM Health Laboratories

  • Clinical Medical Laboratory
  • Beaver Dam, WI
National Provider Identifier
1336739101
Registry record updated Dec 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
CONSULTANTS LABORATORY OF WISCONSIN, LLC
Doing business as
SSM Health Laboratories
Practice address
130 Corporate Dr
Beaver Dam, WI 53916-3116
Phone
(920) 926-5840
NPI assigned
Jan 25, 2021
Last updated
Dec 16, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2022

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

Authorized official

Name
Deborah Lynn Christian
Title
Supervisor, Rev Cycle Patient Accts
Phone
(920) 926-5840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Primary

Addresses

Primary practice location

130 Corporate Dr
Beaver Dam, WI 53916-3116

Mailing address

430 E Division St
Fond Du Lac, WI 54935-4560
Phone (920) 926-5840

Other names 1

  • SSM Health Laboratories Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040311001446 WI Part B Supplier - Independent Clinical Laboratory 8628967205 19 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fond Du Lac, WI; Waupun, WI; Ripon, WI; North Fond Du Lac, WI; Mount Calvary, WI; Mayville, WI; Fox Lake, WI; Markesan, WI…

Other NPIs on the same Medicare enrollment 14

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

View all 14

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
52D0394045Consultants Laboratory of Wi, LLC130 Corporate Dr, Beaver Dam, WI 53916ComplianceJun 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
Consultant Lab Wi Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

92 E Division St
Fond du Lac, WI 54935
Phone (414) 921-0560

N6663 Rolling Meadows Dr
Fond du Lac, WI 54937
Phone (920) 907-3970

100 Evergreen Rd
Mount Calvary, WI 53057
Phone (920) 753-2311

790 Eastgate Dr
Ripon, WI 54971
Phone (920) 745-3180

NPI Registry JSON

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

{
    "created_epoch": "1611532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671148800000",
    "number": "1336739101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354560",
            "telephone_number": "920-926-5840",
            "fax_number": "920-929-0647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CORPORATE DR",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163116",
            "telephone_number": "920-926-5840"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONSULTANTS LABORATORY OF WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-25",
        "last_updated": "2022-12-16",
        "certification_date": "2022-12-16",
        "status": "A",
        "authorized_official_last_name": "CHRISTIAN",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "SUPERVISOR, REV CYCLE PATIENT ACCTS",
        "authorized_official_telephone_number": "920-926-5840"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SSM Health Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.