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CRYSTAL LAKE CLINIC, P.C.
NPI 1316177611
Family Medicine in Kingsley, MI

Active since July 21, 2009CLIA Certified · 2 labs
2283 E M 113, KINGSLEY, MI 49649(231) 882-9661(231) 882-9616 Get Directions Write a Review

NPPES record last updated: November 6, 2018. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Crystal Lake Clinic, P.c. NPPES

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

CRYSTAL LAKE CLINIC, P.C. (NPI 1316177611) is a healthcare organization registered as a family medicine in Kingsley, Michigan and active in the NPI registry since July 2009. The organization holds 2 active CLIA laboratory certificates and lists Richard C Nielsen, President, as its authorized official.

NPPES Registry Identity

NPI1316177611
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCRYSTAL LAKE CLINIC, P.C.
Location Address2283 E M 113Kingsley, MI 49649-9370
Mailing Address6227 Frankfort HwyBenzonia, MI 49616-8632 · (231) 882-9661 · Fax (231) 882-9616
Phone(231) 882-9661
Fax(231) 882-9616
Organization SubpartNo
Authorized OfficialRichard C NielsenPresident · (231) 882-9661
Enumeration DateJuly 21, 2009
Last NPPES UpdateNovember 6, 2018
✔ NPI 1316177611 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
2283 E M 113, Kingsley, MI 49649
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA 2

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 23D0858110

Crystal Lake Clinic · Benzonia, MI
Active · expires Nov 4, 2026
CLIA Number23D0858110
Laboratory TypePhysician Office
Certificate Effective DateNovember 5, 2024
Certificate Expiration DateNovember 4, 2026
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 882-9661
Laboratory LocationCrystal Lake Clinic6227 Frankfort Highway, Benzonia, MI 49616
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 23D2002021

Crystal Lake Clinic PC · Kingsley, MI
Active · expires Jan 5, 2028
CLIA Number23D2002021
Laboratory TypePhysician Office
Certificate Effective DateJanuary 6, 2026
Certificate Expiration DateJanuary 5, 2028
Laboratory DirectorJacob G. Flynn
Laboratory Phone(231) 263-0700
Laboratory LocationCrystal Lake Clinic PC2283 M 113 East, Kingsley, MI 49649
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

ANNA COX
Nurse Practitioner
2283 E M 113
KINGSLEY, MI 49649
Grand Traverse County (231) 263-0700
MS. JENNA LYNN STUMP PA
Physician Assistant
2283 E M 113
KINGSLEY, MI 49649
Grand Traverse County (231) 263-0700
CLEAR SKY COUNSELING, P.C.
Social Worker (Clinical)
2283 E M 113
KINGSLEY, MI 49649
Grand Traverse County (231) 818-7907

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, P.C.'s NPI number?

The NPI number for Crystal Lake Clinic, P.C. is 1316177611. It was assigned to this organization in the NPPES registry on July 21, 2009.

Where is Crystal Lake Clinic, P.C. located?

Crystal Lake Clinic, P.C. is located at 2283 E M 113, Kingsley, MI 49649. The listed phone number is (231) 882-9661.

What is Crystal Lake Clinic, P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Crystal Lake Clinic, P.C. hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Crystal Lake Clinic, P.C. accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Crystal Lake Clinic, P.C. 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, P.C. was last updated on November 6, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 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.