NPIMap

Organization Active NPI

Cornerstone Clinic LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Plover, WI
National Provider Identifier
1861037293
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
CORNERSTONE CLINIC LLC
Practice address
2831 Post Rd Ste 300
Plover, WI 54467-3415
Phone
(715) 600-2798
Fax
(715) 504-1987
NPI assigned
Nov 8, 2019
Last updated
Jan 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Authorized official

Name
Dave Prince
Title
Business Manager
Phone
(715) 600-2798

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary
Integrative Medicine Physician 202D00000X

Addresses

Primary practice location

2831 Post Rd Ste 300
Plover, WI 54467-3415

Mailing address

2831 Post Rd Ste 300
Plover, WI 54467-3415
Phone (715) 600-2798

Other practice location 1

3015 S Main St
Rice Lake, WI 54868-8710
Phone (715) 600-2798

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200122000859 WI Part B Supplier - Clinic/Group Practice 0042645046 Receives reassigned benefits from 17 practitioners
Practice locations: Plover, WI; Rice Lake, WI

National Provider Directory

National Provider Directory

Locations

2558 Post Rd
Plover, WI 54467
Phone (279) 871-5600

2831 Post Rd
Ste 300
Plover, WI 54467
Phone (715) 600-2798

3015 S Main St
Rice Lake, WI 54868
Phone (715) 600-2798

Practitioners & affiliated clinicians

Practitioners 21

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 21

NPI Registry JSON

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

{
    "created_epoch": "1573171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737331200000",
    "number": "1861037293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2831 POST RD STE 300",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "544673415",
            "telephone_number": "715-600-2798",
            "fax_number": "715-600-5182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2831 POST RD STE 300",
            "city": "PLOVER",
            "state": "WI",
            "postal_code": "544673415",
            "telephone_number": "715-600-2798",
            "fax_number": "715-504-1987"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3015 S Main St",
            "address_purpose": "LOCATION",
            "city": "Rice Lake",
            "state": "WI",
            "postal_code": "548688710",
            "country_code": "US",
            "telephone_number": "715-600-2798",
            "fax_number": "715-504-1987",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "CORNERSTONE CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-11-08",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A",
        "authorized_official_last_name": "PRINCE",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "715-600-2798"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "202D00000X",
            "taxonomy_group": "",
            "desc": "Integrative Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plover, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.