CRYSTAL LAKE CLINIC, PC
NPI 1306190475
Family Medicine in Manton, MI
About Crystal Lake Clinic, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
CRYSTAL LAKE CLINIC, PC (NPI 1306190475) is a healthcare organization registered as a family medicine in Manton, Michigan and active in the NPI registry since October 2012. The organization lists Richard C Nielsen, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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, Pc 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, PC, 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.
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, PC's NPI number?
The NPI number for Crystal Lake Clinic, PC is 1306190475. It was assigned to this organization in the NPPES registry on October 29, 2012.
Where is Crystal Lake Clinic, PC located?
Crystal Lake Clinic, PC is located at 115 E 7th St, Manton, MI 49663. The listed phone number is (231) 824-4100.
What is Crystal Lake Clinic, PC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Crystal Lake Clinic, PC enrolled in Medicare?
Yes. Crystal Lake Clinic, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Crystal Lake Clinic, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 23 clinicians in 3 Medicare specialties reassign their Medicare billing to Crystal Lake Clinic, PC. 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.
What insurance does Crystal Lake Clinic, PC accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Crystal Lake Clinic, PC 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, PC was last updated on October 29, 2012. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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, Pc · NPI 1306190475
Family Medicine organization in Manton, Michigan. Organization record, active in the CMS NPPES registry since October 29, 2012.
## Identity
- **NPI:** 1306190475 (Entity type: Organization)
- **Enumerated:** October 29, 2012
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Richard Nielsen, PRESIDENT
## Practice location
- **Address:** 115 E 7TH ST, Manton, MI 49663-9429
- **Phone:** (231) 824-4100 · **Fax:** (231) 824-4108
## 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/1306190475/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 29, 2012
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Source: [NPI Profile](https://npiprofile.com/npi/1306190475) · Data from the CMS NPPES public registry.