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CRYSTAL LAKE CLINIC P.C.
NPI 1053780072
Family Medicine in Elk Rapids, MI

Active since September 21, 2015CLIA Certified · 7 labs
124 AMES ST, ELK RAPIDS, MI 49629(231) 264-8282(231) 264-6655 Get Directions Write a Review

NPPES record last updated: September 21, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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

NPI1053780072
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCRYSTAL LAKE CLINIC P.C.
Location Address124 AMES STElk Rapids, MI 49629-9449
Mailing Address6227 Frankfort HwyBenzonia, MI 49616-8632 · (231) 882-9661 · Fax (231) 882-9616
Phone(231) 264-8282
Fax(231) 264-6655
Organization SubpartNo
Authorized OfficialRichard C NielsenPresident · (231) 882-9661
Enumeration DateSeptember 21, 2015
✔ NPI 1053780072 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

124 AMES ST, Elk Rapids, MI 49629
Open in Google Maps ↗

Other Identifiers 1

Medicare PIN0N38430MI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

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, MI
Active · expires Oct 6, 2027
CLIA Number23D2103176
Laboratory TypePhysician Office
Certificate Effective DateOctober 7, 2025
Certificate Expiration DateOctober 6, 2027
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic, PC124 Ames Street, Elk Rapids, MI 49629
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D2036348

Crystal Lake Clinic PC · Manistee, MI
Active · expires Feb 6, 2028
CLIA Number23D2036348
Laboratory TypePhysician Office
Certificate Effective DateFebruary 7, 2026
Certificate Expiration DateFebruary 6, 2028
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic PC2198 U S 31 South, Manistee, MI 49660
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D2035809

Crystal Lake Clinic PC · Traverse City, MI
Active · expires Jan 24, 2028
CLIA Number23D2035809
Laboratory TypePhysician Office
Certificate Effective DateJanuary 25, 2026
Certificate Expiration DateJanuary 24, 2028
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic PC5191 Rosewood Drive, Traverse City, MI 49685
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D0963736

Crystal Lake Clinic PC · Interlochen, MI
Active · expires Sep 2, 2027
CLIA Number23D0963736
Laboratory TypePhysician Office
Certificate Effective DateSeptember 3, 2025
Certificate Expiration DateSeptember 2, 2027
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic PC1975 Sterling Drive, Interlochen, MI 49643
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D2100386

Crystal Lake Clinic, PC · Traverse City, MI
Active · expires Aug 12, 2027
CLIA Number23D2100386
Laboratory TypePhysician Office
Certificate Effective DateAugust 13, 2025
Certificate Expiration DateAugust 12, 2027
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic, PC4025 Chums Village Drive, Traverse City, MI 49685
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D2134178

Crystal Lake Clinic, P C · Suttons Bay, MI
Active · expires Jul 26, 2027
CLIA Number23D2134178
Laboratory TypePhysician Office
Certificate Effective DateJuly 27, 2025
Certificate Expiration DateJuly 26, 2027
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic, P C650 S West Bay Shore Drive, Suttons Bay, MI 49682
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ELK RAPIDS FAMILY PRACTICE, P.C.
Family Medicine
124 AMES ST
ELK RAPIDS, MI 49629
Antrim County (231) 264-8282
MCLAREN MEDICAL MANAGEMENT INC
Family Medicine
124 AMES ST
ELK RAPIDS, MI 49629
Antrim County (231) 264-8282
LOUIS GHIRINGHELLI
Pharmacist
124 AMES ST
ELK RAPIDS, MI 49629
Antrim County (231) 264-8165
RIVER PHARMACY INC
Pharmacy (Community/Retail Pharmacy)
124 AMES ST
ELK RAPIDS, MI 49629
Antrim County (231) 264-8165
BRITTANY HASKIN PA
Physician Assistant
124 AMES ST
ELK RAPIDS, MI 49629
Antrim County (231) 264-9060

Frequently 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.

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 Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, 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 with the weekly NPPES data releases published by CMS.