GREEN LAKE MEDICAL CLINIC
NPI 1316087885
Clinical Medical Laboratory in Green Lake, WI
NPI Status: Active since February 07, 2007
Contact Information
N6205 BUSSE DRIVE
GREEN LAKE, WI
ZIP 54941
Phone: (920) 294-3444
Fax: (920) 294-6660
- Organization
- Clinical Medical Laboratory
- CLIA Number: 52D2133093
- CLIA Cert. Type: Other - COUNTY JAIL
- CLIA Exp. Date: 07-05-2027
About GREEN LAKE MEDICAL CLINIC
This page provides the complete NPI Profile along with additional information for Green Lake Medical Clinic, a provider established in Green Lake, Wisconsin operating as a Clinical Medical Laboratory. The healthcare provider is registered in the NPI registry with number 1316087885 assigned on February 2007. The practitioner's primary taxonomy code is 291U00000X with license number 17659 (WI). The provider is registered as an organization and their NPI record was last updated 6 years ago. The authorized official of this NPI record is Dr. Thomas Rice Willett D.o. (President)
- NPI
- 1316087885
- Provider Name
- GREEN LAKE MEDICAL CLINIC
- Entity Type
- Organization
- Location Address
- N6205 BUSSE DRIVE GREEN LAKE, WI 54941
- Location Phone
- (920) 294-3444
- Location Fax
- (920) 294-6660
- Mailing Address
- PO BOX 429 N6205 BUSSE DRIVE GREEN LAKE, WI 54941
- Mailing Phone
- (920) 294-3444
- Mailing Fax
- (920) 294-6660
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 02-07-2007
- Last Update Date
- 08-22-2020
- Code Navigator
Establishments like Green Lake Medical Clinic are healthcare facilities that may perform a wide range of laboratory procedures, assisted by doctors and medical technologists. Laboratories can be categorized according to their function as common diagnostic labs or specialty labs that conduct specialized or confirmatory tests. Different clinical laboratories could specialize in clinical chemistry, clinical microbiology, hematology, serology, clinical microscopy, cytopathology, molecular biology, or public health. Please inquire directly with this provider to confirm their test menu.
Clinical labs in the U.S. that perform human testing are regulated by the Centers for Medicare & Medicaid Services (CMS) through the Clinical Laboratory Improvement Amendments (CLIA) program. The purpose of the CLIA program is to guarantee the quality of laboratory testing. This provider has a CLIA number assigned, and undergoes regular inspections to ensure compliance and quality.
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
Clinical Medical Laboratory
- Taxonomy Code
- 291U00000X
- Type
- Laboratories
- License No.
- 17659
- License State
- WI
- Taxonomy Description
- (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
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 |
|---|---|---|---|
| 30071600 | 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
- 52D2133093
- Facility Type
- Other - COUNTY JAIL
- Certificate Effective Date
- July 06, 2025
- Certificate Expiration Date
- July 05, 2027
- Laboratory Director
- LORI LEAHY
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Green Lake Medical Clinic 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.
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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 1316087885, we treat the final digit (5) 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 65. The final step is to find the difference between that total and the next multiple of ten (70 - 65 = 5).
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 65 is 70. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1316087885, enumerated as an "organization" on February 07, 2007.
The provider is located at N6205 BUSSE DRIVE GREEN LAKE, WI 54941 and the phone number is (920) 294-3444.
Clinical Medical Laboratory with taxonomy code 291U00000X.
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.
