CRYSTAL LAKE CLINIC, P.C.
NPI 1417386145
Family Medicine in Empire, MI
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 1417386145) is a healthcare organization registered as a family medicine in Empire, Michigan and active in the NPI registry since November 2013. The organization lists Richard Nielsen, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Crystal Lake Clinic, P.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
23Medicare enrollment records show 23 clinicians reassign Medicare billing to Crystal Lake Clinic, P.C., 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, P.C.'s NPI number?
The NPI number for Crystal Lake Clinic, P.C. is 1417386145. It was assigned to this organization in the NPPES registry on November 4, 2013.
Where is Crystal Lake Clinic, P.C. located?
Crystal Lake Clinic, P.C. is located at 9975 W Ottawa Ave, Empire, MI 49630. The listed phone number is (231) 882-9616.
What is Crystal Lake Clinic, P.C.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Crystal Lake Clinic, P.C. enrolled in Medicare?
Yes. Crystal Lake Clinic, P.C. is registered in the Medicare PECOS enrollment system.
When is Crystal Lake Clinic, P.C.'s Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Michigan, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Crystal Lake Clinic, P.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 23 clinicians in 3 Medicare specialties reassign their Medicare billing to Crystal Lake Clinic, P.C.. 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.
When was this NPI record last updated?
The NPPES record for Crystal Lake Clinic, P.C. was last updated on November 4, 2013. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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, P.c. · NPI 1417386145
Family Medicine organization in Empire, Michigan. Organization record, active in the CMS NPPES registry since November 4, 2013.
## Identity
- **NPI:** 1417386145 (Entity type: Organization)
- **Enumerated:** November 4, 2013
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Richard Nielsen, PRESIDENT
## Practice location
- **Address:** 9975 W OTTAWA AVE, Empire, MI 49630-9618
- **Phone:** (231) 882-9616
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Non-DME Part B, Michigan, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **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/1417386145/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 4, 2013
- **Other identifiers:** Medicare PIN 0N38430 (MI)
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Source: [NPI Profile](https://npiprofile.com/npi/1417386145) · Data from the CMS NPPES public registry.