ST GIANNA MOLLA CLINIC, INC
NPI 1104426477
Clinic/Center - Multi-Specialty in De Pere, WI
NPI Status: Active since October 27, 2020
Contact Information
1716 LAWRENCE DR STE 100
DE PERE, WI
ZIP 54115
Phone: (920) 605-3115
Fax: (920) 486-6826
- Organization
- Clinic/Center
- Multi-Specialty
- Accepts Insurance
- CLIA Number: 52D2213189
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 02-09-2027
About ST GIANNA MOLLA CLINIC, INC
This page provides the complete NPI Profile along with additional information for St Gianna Molla Clinic, Inc, a provider established in De Pere, Wisconsin operating as a Clinic/center, focusing in multi-specialty . The healthcare provider is registered in the NPI registry with number 1104426477 assigned on October 2020. The practitioner's primary taxonomy code is 261QM1300X. The provider is registered as an organization and their NPI record was last updated 3 years ago. St Gianna Molla Clinic, Inc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Robin Goldsmith (President/chief Medical Officer)
- NPI
- 1104426477
- Provider Name
- ST GIANNA MOLLA CLINIC, INC
- Entity Type
- Organization
- Location Address
- 1716 LAWRENCE DR STE 100 DE PERE, WI 54115
- Location Phone
- (920) 605-3115
- Location Fax
- (920) 486-6826
- Mailing Address
- 1716 LAWRENCE DR STE 100 DE PERE, WI 54115
- Mailing Phone
- (920) 605-3115
- Mailing Fax
- (920) 486-6826
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-27-2020
- Last Update Date
- 04-05-2023
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Multi-Specialty
- Taxonomy Code
- 261QM1300X
- Type
- Ambulatory Health Care Facilities
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | |
| 2 | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Anthem Bronze Preferred/Broad 5000 (3 Free PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Bronze Preferred/Broad HSA (+ Incentives) - POS
- Anthem Bronze Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad 1000 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Gold Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Heart Healthy Bronze Preferred/Broad 0 Med Ded ($0 Virtual PCP+$0 Select Drugs+Incentives) - POS
- Anthem Silver Preferred/Broad 4000 ($0 PCP Visits + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad 5500 ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Anthem Silver Preferred/Broad Standard ($0 Virtual PCP + $0 Select Drugs + Incentives) - POS
- Oak $1,300 Gold - PPO
- Oak $2,000 Standard Gold - PPO
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 100163645 | MEDICAID (05) | WI |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D2213189
- Facility Type
- Physician Office
- Certificate Effective Date
- February 10, 2025
- Certificate Expiration Date
- February 09, 2027
- Laboratory Director
- DR. ROBIN GOLDSMITH
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to St Gianna Molla Clinic, Inc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
Reviews for ST GIANNA MOLLA CLINIC, INC
There are currently no reviews for this provider. Be the first person to share your experience with this provider by filling out our review form. Your insights are appreciated and will help others make informed decisions.
NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104426477, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 53. The final step is to find the difference between that total and the next multiple of ten (60 - 53 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 53 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 5 providers are registered at the same or a nearby location.
DE PERE, WI 54115
DE PERE, WI 54115
DE PERE, WI 54115
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104426477, enumerated as an "organization" on October 27, 2020.
The provider is located at 1716 LAWRENCE DR STE 100 DE PERE, WI 54115 and the phone number is (920) 605-3115.
Clinic/Center with taxonomy code 261QM1300X and a focus in Multi-Specialty.
The provider might be accepting Accepts: Anthem Blue Cross and Blue Shield, HealthPartners,. Please consult your insurance carrier or call the provider to verify.
