PROVIDENCE FAMILY MEDICAL CLINIC S.C
NPI 1861857542
Clinic/Center - Primary Care in Glendale, WI
About Providence Family Medical Clinic S.c NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PROVIDENCE FAMILY MEDICAL CLINIC S.C (NPI 1861857542) is a healthcare organization registered as a primary care in Glendale, Wisconsin and active in the NPI registry since December 2015. The organization holds a CLIA Waiver certificate valid through January 26, 2028 and lists Adedapo F Okusanya, President, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
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)
Providence Family Medical Clinic S.c is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to Providence Family Medical Clinic S.C, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (3)
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 Waiver 52D2108037
Providence Family Medical Clinic, Sc · Glendale, 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 Providence Family Medical Clinic S.C's NPI number?
The NPI number for Providence Family Medical Clinic S.C is 1861857542. It was assigned to this organization in the NPPES registry on December 22, 2015.
Where is Providence Family Medical Clinic S.C located?
Providence Family Medical Clinic S.C is located at 2500 W Silver Spring Dr, Glendale, WI 53209. The listed phone number is (414) 800-7171.
What is Providence Family Medical Clinic S.C's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Providence Family Medical Clinic S.C enrolled in Medicare?
Yes. Providence Family Medical Clinic S.C is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Providence Family Medical Clinic S.C?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to Providence Family Medical Clinic S.C, in Family Practice, Nurse Practitioner and Physical Therapist in Private Practice. 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. Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Providence Family Medical Clinic S.C hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 52D2108037) is associated with this NPI, valid through January 26, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Providence Family Medical Clinic S.C accept?
Health plans from Anthem Blue Cross and Blue Shield list Providence Family Medical 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 Providence Family Medical Clinic S.C was last updated on December 22, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.
# Providence Family Medical Clinic S.c · NPI 1861857542
Primary Care organization in Glendale, Wisconsin. Organization record, active in the CMS NPPES registry since December 22, 2015.
## Identity
- **NPI:** 1861857542 (Entity type: Organization)
- **Enumerated:** December 22, 2015
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Organization subpart:** No
- **Authorized official:** Adedapo Okusanya, PRESIDENT
## Practice location
- **Address:** 2500 W SILVER SPRING DR, Glendale, WI 53209-4218
- **Phone:** (414) 800-7171 · **Fax:** (414) 800-7166
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (1), Nurse Practitioner (1), Physical Therapist in Private Practice (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 22, 2015
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1861857542) · Data from the CMS NPPES public registry.