KAUKAUNA CLINIC, S.C.
NPI 1457317273
Family Medicine in Kaukauna, WI

Q: 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.

Q: What is Kaukauna Clinic, S.C.'s specialty?

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

Active since April 21, 2006CLIA 52D0394447 · Certificate of Compliance

305 E 12TH ST, KAUKAUNA, WI 54130(920) 766-4656(920) 766-4659 Get Directions Write a Review

NPPES record last updated: November 13, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Nov 13, 2025, Aug 22, 2020 (2 updates tracked since 2020).

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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

NPI1457317273

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameKAUKAUNA CLINIC, S.C.

Location Address305 E 12TH STKaukauna, WI 54130-2865

Mailing Address305 E 12th StKaukauna, WI 54130-2865 · (920) 766-4656 · Fax (920) 766-4659

Phone(920) 766-4656

Fax(920) 766-4659

Organization SubpartNo

Authorized OfficialPaul RussoPresident · (920) 766-4656

Enumeration DateApril 21, 2006

Last NPPES UpdateNovember 13, 20252 updates tracked since enumeration

NPPES CertifiedNovember 13, 2025

✔ NPI 1457317273 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.

305 E 12TH ST, Kaukauna, WI 54130

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Other Identifiers 1

Medicaid32792500WI

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 Anthem Blue Cross and Blue Shield, Aspirus Health Plan, CareSource (Common Ground Healthcare) and more.Insurance ›

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, WI

Active · expires Oct 20, 2027

CLIA Number52D0394447

Laboratory TypePhysician Office

Certificate Effective DateOctober 21, 2025

Certificate Expiration DateOctober 20, 2027

Laboratory DirectorDr. Gregory A. Johnson

Laboratory Phone(920) 766-4656

Laboratory LocationKaukauna Clinic Sc305 E 12th St, Kaukauna, WI 54130

CLIA data matches this NPI record on: Address Phone

This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Other Providers at the Same Location NPPES 8

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

DR. PAUL H RUSSO MD

Family Medicine