NPIMap

Organization Active NPI

Rock River Community Clinic Inc

  • Federally Qualified Health Center (FQHC)
  • Watertown, WI
National Provider Identifier
1427717115
Registry record updated Jun 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ROCK RIVER COMMUNITY CLINIC INC
Practice address
132 Hospital Dr
Watertown, WI 53098-3304
Phone
(920) 206-7797
Fax
(920) 206-0870
NPI assigned
Dec 10, 2021
Last updated
Jun 2, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
ROCK RIVER COMMUNITY CLINIC INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 2, 2025

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

Authorized official

Name
Olivia Nichols, PHD
Title
Ceo/Executive Director
Phone
(262) 472-6839

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

132 Hospital Dr
Watertown, WI 53098-3304

Mailing address

1461 W Main St
Whitewater, WI 53190-1568
Phone (262) 472-6839

Other practice location 1

415 S 8th St
Watertown, WI 53094-4730
Phone (920) 206-7797

Other names 1

  • Rock River Community Clinic-Watertown Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241125000282 WI Part A Provider - Federally Qualified Health Center (FQHC) 3971906983 Practice locations: Watertown, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1427717115. Details of each certification follow.

Federally qualified health center certification: CCN 521046

Legal name
ROCK RIVER COMMUNITY CLINIC INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 31, 2024
Last certification
Oct 31, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 2020 in WI
Enrollment address
132 Hospital Dr
Watertown, WI 53098-3304

Other NPIs with the same Medicare PAC ID 1

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

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
52D2312382Rock River Community Clinic, Inc132 Hospital Drive, Watertown, WI 53098Certificate of waiverOct 9, 2026

National Provider Directory

National Provider Directory
Tax ID family
Rock River Community Clinic4 organizations share this tax ID, including this one
Part of
Rock River Community Clinic

Other organizations with this tax ID 3

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

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
Olivia Nichols Individual Corporate OfficerCeo Dec 1, 2022
Dawn Miller Individual W-2 Managing EmployeeRevenue Cycle Manager Jul 24, 2023

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": "1639094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1427717115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1461 W MAIN ST",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531901568",
            "telephone_number": "262-472-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "132 HOSPITAL DR",
            "city": "WATERTOWN",
            "state": "WI",
            "postal_code": "530983304",
            "telephone_number": "920-206-7797",
            "fax_number": "920-206-0870"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "415 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Watertown",
            "state": "WI",
            "postal_code": "530944730",
            "country_code": "US",
            "telephone_number": "920-206-7797",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ROCK RIVER COMMUNITY CLINIC INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ROCK RIVER COMMUNITY CLINIC INC",
        "enumeration_date": "2021-12-10",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "NICHOLS",
        "authorized_official_first_name": "OLIVIA",
        "authorized_official_title_or_position": "CEO/EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "262-472-6839",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rock River Community Clinic-Watertown",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Watertown, WI

Sources for this page

Verify at the official NPI Registry.