ST GIANNA MOLLA CLINIC, INC
NPI 1104426477
Clinic/Center - Multi-Specialty in De Pere, WI
About St Gianna Molla Clinic, Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
ST GIANNA MOLLA CLINIC, INC (NPI 1104426477) is a healthcare organization registered as a multi-specialty in De Pere, Wisconsin and active in the NPI registry since October 2020. The organization holds a CLIA Waiver certificate valid through February 9, 2027 and lists Robin Goldsmith, President/chief Medical Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
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)
St Gianna Molla Clinic, Inc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
11Medicare enrollment records show 11 clinicians reassign Medicare billing to St Gianna Molla Clinic, Inc, which bills Medicare for the services they deliver. Of these, 7 practice at this address and 9 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (11)
Source: 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
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 52D2213189
St Gianna Clinics · De Pere, WIFrequently 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 St Gianna Molla Clinic, Inc's NPI number?
The NPI number for St Gianna Molla Clinic, Inc is 1104426477. It was assigned to this organization in the NPPES registry on October 27, 2020.
Where is St Gianna Molla Clinic, Inc located?
St Gianna Molla Clinic, Inc is located at 1716 Lawrence Dr Ste 100, De Pere, WI 54115. The listed phone number is (920) 605-3115.
What is St Gianna Molla Clinic, Inc's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.
Is St Gianna Molla Clinic, Inc enrolled in Medicare?
Yes. St Gianna Molla Clinic, Inc is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through St Gianna Molla Clinic, Inc?
According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 6 Medicare specialties reassign their Medicare billing to St Gianna Molla Clinic, Inc. 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 Family Practice (3), Nurse Practitioner (2) and Obstetrics/Gynecology (2). Of these, 7 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does St Gianna Molla Clinic, Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 52D2213189) is associated with this NPI, valid through February 9, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does St Gianna Molla Clinic, Inc accept?
Health plans from Anthem Blue Cross and Blue Shield list St Gianna Molla Clinic, Inc 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 St Gianna Molla Clinic, Inc was last updated on April 5, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# St Gianna Molla Clinic, Inc · NPI 1104426477
Multi-Specialty organization in De Pere, Wisconsin. Organization record, active in the CMS NPPES registry since October 27, 2020.
## Identity
- **NPI:** 1104426477 (Entity type: Organization)
- **Enumerated:** October 27, 2020
- **Primary specialty:** Clinic/Center - Multi-Specialty · taxonomy 261QM1300X
- **Organization subpart:** No
- **Authorized official:** Robin Goldsmith, PRESIDENT/CHIEF MEDICAL OFFICER
## Practice location
- **Address:** 1716 LAWRENCE DR STE 100, De Pere, WI 54115-9108
- **Phone:** (920) 605-3115 · **Fax:** (920) 486-6826
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 11 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (3), Nurse Practitioner (2), Obstetrics/Gynecology (2); 7 practice at this address and 9 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 5, 2023
- **Other identifiers:** Medicaid 100163645 (WI)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1104426477) · Data from the CMS NPPES public registry.