NPIMap

Organization Active NPI

The Lakes Community Health Center, Inc

Doing business as NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • White Lake, WI
National Provider Identifier
1679983423
Registry record updated Oct 13, 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
524 Bissell Street
White Lake, WI 54491
Phone
(715) 882-2353
Fax
(715) 882-2355
NPI assigned
May 2, 2014
Last updated
Oct 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 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 WI Primary

Addresses

Primary practice location

524 Bissell Street
White Lake, WI 54491

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
O20101019000186 WI Part B Supplier - Clinic/Group Practice 0840366654 Receives reassigned benefits from 119 practitioners
17 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: White Lake, WI; Washburn, WI; Turtle Lake, WI; Solon Springs, WI; Eau Claire, WI; Rice Lake, WI; Poplar, WI; Park Falls, WI…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679983423. Details of each certification follow.

  • CCN 521853 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 521853

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
NORTHERN HEALTH CENTERS, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Sep 5, 2014
Last certification
Sep 5, 2014
Ownership / control type
Non-profit – other
Most recent change of ownership
Feb 1, 2019 (1 total)
Facility address
524 Bissell St
White Lake, WI 54491
Related CCNs
521801

Other NPIs on the same Medicare enrollment 17

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

View all 17

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
52D2081335Northlakes Community Clinic White Lake524 Bissell Street, White Lake, WI 54491Certificate of waiverJul 22, 2028

National Provider Directory

National Provider Directory

Locations

15954 Rivers Edge Dr
Hayward, WI 54843

7665 US Highway 2
Iron River, WI 54847
Phone (715) 372-5001

1435 Cleveland Ave
Marinette, WI 54143
Phone (715) 504-6419

600 W Shell Creek Rd
Minong, WI 54859
Phone (715) 364-8565

Practitioners & affiliated clinicians

Practitioners 139

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.

View all 139

NPI Registry JSON

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

{
    "created_epoch": "1398988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697155200000",
    "number": "1679983423",
    "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": "524 BISSELL STREET",
            "city": "WHITE LAKE",
            "state": "WI",
            "postal_code": "54491",
            "telephone_number": "715-882-2353",
            "fax_number": "715-882-2355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-02",
        "last_updated": "2023-10-13",
        "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": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NorthLakes Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Lake, WI

Sources for this page

Verify at the official NPI Registry.