KAUKAUNA CLINIC, S.C.
NPI 1457317273
Family Medicine in Kaukauna, WI
About Kaukauna Clinic, S.c. NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KAUKAUNA CLINIC, S.C. (NPI 1457317273) is a healthcare organization registered as a family medicine in Kaukauna, Wisconsin and active in the NPI registry since April 2006. The organization holds a CLIA Certificate of Compliance certificate valid through October 20, 2027 and lists Paul Russo, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
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)
Kaukauna Clinic, S.c. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
12Medicare enrollment records show 12 clinicians reassign Medicare billing to Kaukauna Clinic, S.C., which bills Medicare for the services they deliver. Of these, 9 practice at this address and 10 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 2
Clinicians, nearest first (12)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 52D0394447
Kaukauna Clinic Sc · Kaukauna, WIFrequently 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 Kaukauna Clinic, S.C.'s NPI number?
The NPI number for Kaukauna Clinic, S.C. is 1457317273. It was assigned to this organization in the NPPES registry on April 21, 2006.
Where is Kaukauna Clinic, S.C. located?
Kaukauna Clinic, S.C. is located at 305 E 12th St, Kaukauna, WI 54130. The listed phone number is (920) 766-4656.
What is Kaukauna Clinic, S.C.'s specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Kaukauna Clinic, S.C. enrolled in Medicare?
Yes. Kaukauna Clinic, S.C. is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Kaukauna Clinic, S.C.?
According to the CMS Revalidation Reassignment List (October 2026 release), 12 clinicians in 2 Medicare specialties reassign their Medicare billing to Kaukauna Clinic, S.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 Family Practice (9) and Nurse Practitioner (3). Of these, 9 practice at this address and 10 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Kaukauna Clinic, S.C. hold a CLIA laboratory certificate?
Yes. A Certificate of Compliance (number 52D0394447) is associated with this NPI, valid through October 20, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Kaukauna Clinic, S.C. accept?
Health plans from Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare), HealthPartners and Quartz and 1 other insurer list Kaukauna Clinic, S.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 Kaukauna Clinic, S.C. was last updated on November 13, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.
# Kaukauna Clinic, S.c. · NPI 1457317273
Family Medicine organization in Kaukauna, Wisconsin. Organization record, active in the CMS NPPES registry since April 21, 2006.
## Identity
- **NPI:** 1457317273 (Entity type: Organization)
- **Enumerated:** April 21, 2006
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Paul Russo, PRESIDENT
## Practice location
- **Address:** 305 E 12TH ST, Kaukauna, WI 54130-2865
- **Phone:** (920) 766-4656 · **Fax:** (920) 766-4659
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 12 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (9), Nurse Practitioner (3); 9 practice at this address and 10 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 13, 2025
- **Other identifiers:** Medicaid 32792500 (WI)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1457317273) · Data from the CMS NPPES public registry.