PRAIRIE CLINIC, SC
NPI 1215349196
Physician Assistant - Medical in Sauk City, WI

Q: What is Prairie Clinic, Sc's NPI number?

The NPI number for Prairie Clinic, Sc is 1215349196. It was assigned to this organization in the NPPES registry on May 27, 2014.

Q: What is Prairie Clinic, Sc's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Active since May 27, 2014CLIA 52D0393107 · Certificate of Compliance

112 HELEN ST, SAUK CITY, WI 53583(608) 643-3351(608) 643-3621 Get Directions Write a Review

NPPES record last updated: April 15, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Prairie Clinic, Sc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRAIRIE CLINIC, SC (NPI 1215349196) is a healthcare organization registered as a medical in Sauk City, Wisconsin and active in the NPI registry since May 2014. The organization holds a CLIA Certificate of Compliance certificate valid through December 9, 2027 and lists Steven J Johnson, Medical Doctor, as its authorized official.

NPPES Registry Identity

NPI1215349196

Entity TypeOrganization

Primary Taxonomy363AM0700X

Legal Business NamePRAIRIE CLINIC, SC

Location Address112 HELEN STSauk City, WI 53583-1101

Mailing Address112 Helen StSauk City, WI 53583-1101 · (608) 643-3351 · Fax (608) 643-3621

Phone(608) 643-3351

Fax(608) 643-3621

Organization SubpartNo

Authorized OfficialSteven J JohnsonMedical Doctor · (608) 643-3351

Enumeration DateMay 27, 2014

Last NPPES UpdateApril 15, 2024

NPPES CertifiedApril 15, 2024

✔ NPI 1215349196 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

112 HELEN ST, Sauk City, WI 53583

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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

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 Compliance 52D0393107

Sauk Prairie Healthcare, Inc Dba Prairie Clinic · Sauk City, WI

Active · expires Dec 9, 2027

CLIA Number52D0393107

Laboratory TypePhysician Office

Certificate Effective DateDecember 10, 2025

Certificate Expiration DateDecember 9, 2027

Laboratory DirectorDr. Steven Johnson

Laboratory Phone(608) 643-3351

Laboratory LocationSauk Prairie Healthcare, Inc Dba Prairie Clinic112 Helen St, Sauk City, WI 53583

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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Other Providers at the Same Location NPPES 20

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

RACHEL M KADERAVEK PA

Physician Assistant (Medical)