NPIMap

Organization Active NPI

The Lakes Community Health Center, Inc

Doing business as NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Park Falls, WI
National Provider Identifier
1437619202
Registry record updated Oct 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
THE LAKES COMMUNITY HEALTH CENTER, INC
Doing business as
NorthLakes Community Clinic
Practice address
110 2ND Ave N
Park Falls, WI 54552-1214
Phone
(715) 762-2950
Fax
(715) 762-3561
NPI assigned
Mar 20, 2019
Last updated
Oct 12, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2023

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

Authorized official

Name
Rebecca Rice
Title
Ceo
Phone
(715) 372-5001

Specialties & licenses 1

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

Addresses

Primary practice location

110 2ND Ave N
Park Falls, WI 54552-1214

Mailing address

15735 W US Highway 63
Hayward, WI 54843-6475
Phone (715) 934-0710

Other names 1

  • NorthLakes Community Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231012000161 WI Part A Provider - Federally Qualified Health Center (FQHC) 0840366654 Practice locations: Park Falls, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437619202. Details of each certification follow.

Federally qualified health center certification: CCN 521030

Legal name
THE LAKES COMMUNITY HEALTH CENTER INC
Doing business as
NORTHLAKES COMMUNITY CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 4, 2023
Last certification
Oct 4, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 14, 2007 in WI
Enrollment address
110 2ND Ave N
Park Falls, WI 54552-1214

Other NPIs with the same Medicare PAC ID 12

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
52D2157187Northlakes Community Clinic110 2ND Ave N, Park Falls, WI 54552Certificate of waiverOct 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
The Lakes Community Health Center Inc23 organizations share this tax ID, including this one

Other organizations with this tax ID 22

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

View all 22

Locations

110 2nd Ave N
Park Falls, WI 54552
Phone (715) 762-2950

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
Rebecca S Rice Individual Corporate OfficerCeo Aug 19, 2010
W-2 Managing EmployeeCeo Mar 5, 2009
Frank G Suo Individual Corporate DirectorBoard of Directors President Jan 1, 2022

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": "1553040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697068800000",
    "number": "1437619202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15735 W US HIGHWAY 63",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548436475",
            "telephone_number": "715-934-0710",
            "fax_number": "715-598-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 2ND AVE N",
            "city": "PARK FALLS",
            "state": "WI",
            "postal_code": "545521214",
            "telephone_number": "715-762-2950",
            "fax_number": "715-762-3561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-20",
        "last_updated": "2023-10-12",
        "certification_date": "2023-10-12",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "715-372-5001"
    },
    "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": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Falls, WI

Sources for this page

Verify at the official NPI Registry.