NPIMap

Organization Active NPI

The Lakes Community Health Center, Inc

Doing business as NorthLakes Community Clinic

  • Federally Qualified Health Center (FQHC)
  • Ashland, WI
National Provider Identifier
1841742673
Registry record updated Feb 5, 2019
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
300 Main Street West
Ashland, WI 54806-3696
Phone
(715) 685-2200
Fax
(715) 685-1185
NPI assigned
Oct 27, 2016
Last updated
Feb 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2019

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

300 Main Street West
Ashland, WI 54806-3696

Mailing address

15954 Rivers Edge Dr Ste 304
Hayward, WI 54843-7894
Phone (715) 634-2541

Other identifiers 1

IdentifierTypeStateIssuer
1811178825MedicaidWI

Other names 1

  • NorthLakes Community Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

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…
O20190311002247 WI Part A Provider - Federally Qualified Health Center (FQHC) 0840366654 1 other NPI on this enrollment
Practice locations: Ashland, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841742673. Details of each certification follow.

Federally qualified health center certification: CCN 521870

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
Mar 11, 2019
Last certification
Mar 11, 2019
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
May 14, 2007 in WI
Enrollment address
300 Main St W
Ashland, WI 54806-1639

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 17

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

View all 17

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

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Lisa Kingfisher Individual Corporate DirectorBoard of Directors Jan 1, 2024
Amy Klebe Individual Corporate Director Jan 1, 2024
Jason Martell Individual Corporate DirectorBoard of Directors Jan 1, 2024
Joann Fleming Individual Corporate Director Jan 1, 2024
Rebecca S Rice Individual Corporate OfficerCeo Aug 19, 2010
W-2 Managing Employee Mar 5, 2009
Nikolai Eliot Individual Corporate Director Jan 1, 2024
John B Schrock Individual Corporate Director Jan 1, 2010
David Krochalk Individual Corporate Director Jan 1, 2024
Michael Flaherty Individual Corporate DirectorBoard of Directors Jan 1, 2024
Michael Stamp Individual Corporate DirectorBoard of Directors Jan 1, 2024
Mary Jo Becker Individual Corporate DirectorBoard of Directors Jan 1, 2024

Practitioners & affiliated clinicians

Practitioners 1

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": "1477526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1549324800000",
    "number": "1841742673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15954 RIVERS EDGE DR STE 304",
            "city": "HAYWARD",
            "state": "WI",
            "postal_code": "548437894",
            "telephone_number": "715-634-2541",
            "fax_number": "715-598-4881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 MAIN STREET WEST",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548063696",
            "telephone_number": "715-685-2200",
            "fax_number": "715-685-1185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE LAKES COMMUNITY HEALTH CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-27",
        "last_updated": "2019-02-05",
        "status": "A",
        "authorized_official_last_name": "RICE",
        "authorized_official_first_name": "REBA",
        "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": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811178825",
            "state": "WI"
        }
    ],
    "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 Ashland, WI

Sources for this page

Verify at the official NPI Registry.