Randolph Community Clinic SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

36988020 Issued in WI

Legal business name

RANDOLPH COMMUNITY CLINIC SC

Practice address

504 S High Street
Randolph, WI 53956

Phone

(920) 326-5060

Fax

(920) 326-5061

NPI assigned

Nov 1, 2006

Last updated

Apr 20, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Melissa Elaine Lucarelli, MDNPI 1336102169

Title

President

Phone

(920) 326-5060

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

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.

• Melissa Elaine Lucarelli, MD

  • Family Medicine Physician
  • Randolph, WI
  • NPI 1336102169
  Medicare reassignment Care Compare group Authorized official
• Teresa J Wiersma, NP

  • Family Nurse Practitioner
  • Randolph, WI
  • NPI 1417931833
  Medicare reassignment Care Compare group NPD
• Linda Katherine Mulder, PA

  • Physician Assistant
  • Randolph, WI
  • NPI 1013235803
  Medicare reassignment Care Compare group
• Jon A Arnason, MD

  • Rheumatology Physician
  • Madison, WI
  • NPI 1265760433
  NPD (past)
• Burton Dale Cox Jr., DO

  • Family Medicine Physician
  • Boscobel, WI
  • NPI 1144382011
  NPD (past)
• Rene A Gellings, PA C

  • Physician Assistant
  • Columbus, WI
  • NPI 1154384857
  NPD (past)
• Richard J Qualy, MD

  • Family Medicine Physician
  • Portage, WI
  • NPI 1124041728
  NPD (past)

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208649600000",
    "number": "1497832257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 S HIGH ST",
            "address_2": "PO BOX 101",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "539561499",
            "telephone_number": "920-326-5060",
            "fax_number": "920-326-5061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "504 S HIGH STREET",
            "city": "RANDOLPH",
            "state": "WI",
            "postal_code": "53956",
            "telephone_number": "920-326-5060",
            "fax_number": "920-326-5061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RANDOLPH COMMUNITY CLINIC SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2008-04-20",
        "status": "A",
        "authorized_official_last_name": "LUCARELLI",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "ELAINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-326-5060",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "36988020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CH8761",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "N96",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32327000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stefanie Jo Moldenhauer, RN
• Linda Katherine Mulder, PA
• Susan K North, PTA
• NSH Randolph LLC (Continental Manor of Randolph Health Services)
• Kristen Rabensdorf
• Randolph Community Rescue Ambulance
• Randolph Family Dental LLC
• Randolph School District
• Shannon N Sandstrom, NP
• Emily J Seltzner, RD

• Family Medicine Physician in Randolph, WI
• Providers in Randolph, WI by specialty
• Family Medicine Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.