CRYSTAL LAKE CLINIC P.C.
NPI 1053780072
Family Medicine in Elk Rapids, MI
About Crystal Lake Clinic P.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CRYSTAL LAKE CLINIC P.C. (NPI 1053780072) is a healthcare organization registered as a family medicine in Elk Rapids, Michigan and active in the NPI registry since September 2015. The organization holds 7 active CLIA laboratory certificates and lists Richard C Nielsen, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Crystal Lake Clinic P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
23Medicare enrollment records show 23 clinicians reassign Medicare billing to Crystal Lake Clinic P.C., which bills Medicare for the services they deliver. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 3
Nearest to this location (20)
See all 23Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA 7
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 23D2103176
Crystal Lake Clinic, PC · Elk Rapids, MICertificate of Waiver 23D2049142
Crystal Lake Clinic P C · Manton, MICertificate of Waiver 23D2036348
Crystal Lake Clinic PC · Manistee, MICertificate of Waiver 23D2035809
Crystal Lake Clinic PC · Traverse City, MICertificate of Waiver 23D0963736
Crystal Lake Clinic PC · Interlochen, MICertificate of Waiver 23D2100386
Crystal Lake Clinic, PC · Traverse City, MIFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Crystal Lake Clinic P.C.'s NPI number?
The NPI number for Crystal Lake Clinic P.C. is 1053780072. It was assigned to this organization in the NPPES registry on September 21, 2015.
Where is Crystal Lake Clinic P.C. located?
Crystal Lake Clinic P.C. is located at 124 Ames St, Elk Rapids, MI 49629. The listed phone number is (231) 264-8282.
What is Crystal Lake Clinic P.C.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Crystal Lake Clinic P.C. enrolled in Medicare?
Yes. Crystal Lake Clinic P.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Crystal Lake Clinic P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 23 clinicians in 3 Medicare specialties reassign their Medicare billing to Crystal Lake Clinic P.C.. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (11), Family Practice (10) and Internal Medicine (2). Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Crystal Lake Clinic P.C. hold CLIA laboratory certificates?
Yes. 7 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.
What insurance does Crystal Lake Clinic P.C. accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Crystal Lake Clinic P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Crystal Lake Clinic P.C. was last updated on September 21, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Crystal Lake Clinic P.c. · NPI 1053780072
Family Medicine organization in Elk Rapids, Michigan. Organization record, active in the CMS NPPES registry since September 21, 2015.
## Identity
- **NPI:** 1053780072 (Entity type: Organization)
- **Enumerated:** September 21, 2015
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Richard Nielsen, PRESIDENT
## Practice location
- **Address:** 124 AMES ST, Elk Rapids, MI 49629-9449
- **Phone:** (231) 264-8282 · **Fax:** (231) 264-6655
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 23 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Nurse Practitioner (11), Family Practice (10), Internal Medicine (2); [full list](https://npiprofile.com/npi/1053780072/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** September 21, 2015
- **Other identifiers:** Medicare PIN 0N38430 (MI)
- **CLIA laboratory certificates:** 7 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1053780072) · Data from the CMS NPPES public registry.