NPIMap

Individual provider Active NPI

Courtney McClintic, MD

  • Family Medicine Physician
  • Green Lake, WI
National Provider Identifier
1467080739
Registry record updated Jul 28, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
82312 Issued in WI
Practice address
670 County Road a
Green Lake, WI 54941-8608
Phone
(920) 294-0100
Fax
(920) 294-0123
NPI assigned
Mar 31, 2020
Last updated
Jul 28, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 82312 WI Primary

Addresses

Primary practice location

670 County Road a
Green Lake, WI 54941-8608

Mailing address

670 County Road a
Green Lake, WI 54941-8608
Phone (920) 294-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230810000965 WI Practitioner - Family Practice 3577925346 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Central Michigan College of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Thedacare, IncorporatedGroup PAC ID 1759294887, 654 clinicians

Practice addresses (Care Compare)

670 Country Rd a
Green Lake, WI 54941-8608
Phone (920) 294-0100

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
82312WIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 3, 2026 Accepting new patients
Thedacare, Incorporated Family Medicine CurrentSince Jul 20, 2023 Accepting new patients
Thedacare Medical Center - Berlin, Inc. CurrentSince Jan 3, 2026 Accepting new patients

Locations

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

670 County Road A
Green Lake, WI 54941
Phone (920) 294-0100

3 Neenah Ctr
Neenah, WI 54956
Phone (920) 454-4229

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

Interoperability endpoints

  • Direct secure messaging: cmcclintic332508@direct.thedacare.org

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1585612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1467080739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "670 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418608",
            "telephone_number": "920-294-0100",
            "fax_number": "920-294-0123"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 COUNTY ROAD A",
            "city": "GREEN LAKE",
            "state": "WI",
            "postal_code": "549418608",
            "telephone_number": "920-294-0100",
            "fax_number": "920-294-0123"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCLINTIC",
        "first_name": "COURTNEY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-31",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "82312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Lake, WI

Sources for this page

Verify at the official NPI Registry.