NPIMap

Organization Active NPI

La Clinica de Los Campesinos, Inc

  • Federally Qualified Health Center (FQHC)
  • Stevens Point, WI
National Provider Identifier
1790786929
Registry record updated Sep 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
LA CLINICA DE LOS CAMPESINOS, INC
Practice address
2501 Main St
Stevens Point, WI 54481-4000
Phone
(715) 254-9072
Fax
(715) 254-9106
NPI assigned
Aug 10, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2026

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

Authorized official

Name
Nicole Danger
Title
Director of Patient Financial Ser.
Phone
(800) 942-5330

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X WI
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X WI
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

2501 Main St
Stevens Point, WI 54481-4000

Mailing address

PO Box 1440
Wautoma, WI 54982-1440
Phone (920) 787-5514

Other practice location 1

207 S University Ave
Beaver Dam, WI 53916-2450
Phone (920) 356-5012

Other practice location 2

1701 N Spring St
Beaver Dam, WI 53916-1178
Phone (920) 644-0317

Other practice location 3

302 W Lake St
Friendship, WI 53934-9698
Phone (800) 942-5330

Other practice location 4

2719 Calumet Ave
Manitowoc, WI 54220-5546
Phone (800) 942-5330

Other practice location 5

880 Herriot Dr
Mauston, WI 53948-2031
Phone (608) 847-6700

Other practice location 6

1721 Saemann Ave
Sheboygan, WI 53081-2342
Phone (800) 942-5330

Other practice location 7

400 S Townline Rd
Wautoma, WI 54982-6922
Phone (920) 787-5514

Other practice location 8

908 W Washington St
West Bend, WI 53095-2430
Phone (800) 942-5330

Other identifiers 8

IdentifierTypeStateIssuer
100224438MedicaidWI
100084424MedicaidWI
100076692MedicaidWI
100237113MedicaidWI
32955200MedicaidWI
100080272MedicaidWI
100076513MedicaidWI
100253468MedicaidWI

Other names 1

  • Noble Community Clinics Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL WAUTOMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI5 enrollments

Enrollment records 5

Enrollment IDStateProvider typePAC IDDetails
O20030331000042 WI Part A Provider - Federally Qualified Health Center (FQHC) 8729996574 Practice locations: Wautoma, WI
O20040806000058 WI Part B Supplier - Clinic/Group Practice 8729996574 Receives reassigned benefits from 26 practitioners
Practice locations: Wautoma, WI; Stevens Point, WI; Mauston, WI; Friendship, WI; Beaver Dam, WI
O20180718000361 WI Part A Provider - Federally Qualified Health Center (FQHC) 8729996574 Practice locations: Friendship, WI
O20230620002007 WI Part A Provider - Federally Qualified Health Center (FQHC) 8729996574 Practice locations: Stevens Point, WI
O20240315000308 WI Part A Provider - Federally Qualified Health Center (FQHC) 8729996574 Practice locations: Beaver Dam, WI

Other NPIs with the same Medicare PAC ID 2

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

Federally qualified health center certification: CCN 521823

Legal name
LA CLINICA DE LOS CAMPESINOS, INC
Doing business as
NOBLE COMMUNITY CLINICS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 1, 2003
Last certification
Jul 1, 2003
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1973 in WI
Enrollment address
400 S Townline Rd
Wautoma, WI 54982-6922

Federally qualified health center certification: CCN 521865

Legal name
LA CLINICA DE LOS CAMPESINOS, INC
Doing business as
NOBLE COMMUNITY CLINICS - FRIENDSHIP
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 18, 2018
Last certification
Jul 18, 2018
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1973 in WI
Enrollment address
302 W Lake St
Friendship, WI 53934-9698

Federally qualified health center certification: CCN 521012

Legal name
LA CLINICA DE LOS CAMPESINOS, INC
Doing business as
NOBLE COMMUNITY CLINICS STEVENS POINT
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 31, 2023
Last certification
May 31, 2023
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1973 in WI
Enrollment address
2501 Main St
Stevens Point, WI 54481-4000

Federally qualified health center certification: CCN 521032

Legal name
LA CLINICA DE LOS CAMPESINOS, INC
Doing business as
NOBLE COMMUNITY CLINICS BEAVER DAM
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 14, 2024
Last certification
Mar 14, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 5, 1976 in WI
Enrollment address
1701 N Spring St
Beaver Dam, WI 53916-1178

National Provider Directory

National Provider Directory

Locations

302 W Lake St
Friendship, WI 53934
Phone (608) 339-3326

880 Herriot Dr
Mauston, WI 53948
Phone (608) 847-6700

3504 E Maria Dr
Stevens Point, WI 54481
Phone (715) 342-8060

Ownership & related parties

All disclosed owners & managing parties 13

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Shelley Individual Corporate Director Dec 28, 2023
Corporate DirectorBoard Member Dec 28, 2023
Roman J Mullen Individual Corporate Director Mar 26, 2025
Corporate DirectorBoard Member Mar 26, 2025
Erin Lamore Individual Corporate DirectorEnrollment and Contract Specialist Feb 23, 2022
Sheila Shaw Individual Corporate Director Sep 23, 2021
Corporate DirectorBoard Member Sep 23, 2021
Heidi Delgadillo Individual Corporate Director May 26, 2022
Corporate DirectorBoard Member May 26, 2022
Lora Blasius Individual Corporate Director Dec 22, 2022
Corporate DirectorBoard Member Dec 22, 2022
Alma Torres Individual Corporate Director Mar 26, 2025
Corporate DirectorBoard Member Mar 26, 2025
Laura a Waldvogel Individual Corporate DirectorCeo Jul 27, 2015
W-2 Managing EmployeeCeo Dec 21, 2016
Corporate DirectorCeo Dec 21, 2016
W-2 Managing EmployeeCeo Jul 25, 2015
Corporate OfficerCeo Dec 21, 2016
Corporate OfficerCeo Dec 21, 2016 100%
W-2 Managing EmployeeCeo Dec 21, 2016 100%
Damaris Thome Individual Corporate Director Nov 19, 2020
Corporate DirectorBoard Member Nov 19, 2020
Paul Theyel Individual Corporate Director Jun 1, 2011
Corporate OfficerVice Chair Person Jun 1, 2011
Corporate DirectorBoard Member Jun 1, 2011
La Clinica de Los Campesinos, Inc Organization, Wautoma, WI Corporation Operational/Managerial Control Dec 21, 2016
Juanita Olivas Individual Corporate Director Dec 27, 2018
Corporate DirectorBoard Member Dec 27, 2018
Frederick Johannes Individual Corporate Director Nov 1, 2015
Corporate DirectorBoard Member Aug 1, 2015
Corporate DirectorBoard Member Nov 1, 2015

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners 70

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 70

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
52D2154235La Clinica de Los Campesinos, Inc302 West Lake Street, Friendship, WI 53934Certificate of waiverSep 9, 2026
52D2296105La Clinica de Los Campesinos, Inc1701 North Spring Street, Beaver Dam, WI 53916Certificate of waiverDec 20, 2027

NPI Registry JSON

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

{
    "created_epoch": "1123632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1789084800000",
    "number": "1790786929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1440",
            "city": "WAUTOMA",
            "state": "WI",
            "postal_code": "549821440",
            "telephone_number": "920-787-5514",
            "fax_number": "920-787-4737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 MAIN ST",
            "city": "STEVENS POINT",
            "state": "WI",
            "postal_code": "544814000",
            "telephone_number": "715-254-9072",
            "fax_number": "715-254-9106"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "207 S University Ave",
            "address_purpose": "LOCATION",
            "city": "Beaver Dam",
            "state": "WI",
            "postal_code": "539162450",
            "country_code": "US",
            "telephone_number": "920-356-5012",
            "fax_number": "920-273-3169",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 N Spring St",
            "address_purpose": "LOCATION",
            "city": "Beaver Dam",
            "state": "WI",
            "postal_code": "539161178",
            "country_code": "US",
            "telephone_number": "920-644-0317",
            "fax_number": "920-644-0318",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "302 W Lake St",
            "address_purpose": "LOCATION",
            "city": "Friendship",
            "state": "WI",
            "postal_code": "539349698",
            "country_code": "US",
            "telephone_number": "800-942-5330",
            "fax_number": "608-474-4309",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2719 Calumet Ave",
            "address_purpose": "LOCATION",
            "city": "Manitowoc",
            "state": "WI",
            "postal_code": "542205546",
            "country_code": "US",
            "telephone_number": "800-942-5330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "880 Herriot Dr",
            "address_purpose": "LOCATION",
            "city": "Mauston",
            "state": "WI",
            "postal_code": "539482031",
            "country_code": "US",
            "telephone_number": "608-847-6700",
            "fax_number": "608-847-6122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1721 Saemann Ave",
            "address_purpose": "LOCATION",
            "city": "Sheboygan",
            "state": "WI",
            "postal_code": "530812342",
            "country_code": "US",
            "telephone_number": "800-942-5330",
            "fax_number": "920-787-9219",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 S Townline Rd",
            "address_purpose": "LOCATION",
            "city": "Wautoma",
            "state": "WI",
            "postal_code": "549826922",
            "country_code": "US",
            "telephone_number": "920-787-5514",
            "fax_number": "920-787-4737",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "908 W Washington St",
            "address_purpose": "LOCATION",
            "city": "West Bend",
            "state": "WI",
            "postal_code": "530952430",
            "country_code": "US",
            "telephone_number": "800-942-5330",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LA CLINICA DE LOS CAMPESINOS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-10",
        "last_updated": "2026-09-11",
        "certification_date": "2026-09-11",
        "status": "A",
        "authorized_official_last_name": "DANGER",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "DIRECTOR OF PATIENT FINANCIAL SER.",
        "authorized_official_telephone_number": "800-942-5330"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100224438",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100084424",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100076692",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100237113",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32955200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100080272",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100076513",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100253468",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "WAUTOMA",
            "affiliation": "N",
            "address_1": "400 S Townline Rd",
            "city": "Wautoma",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549826922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Noble Community Clinics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stevens Point, WI

Sources for this page

Verify at the official NPI Registry.