DAGAN WELLNESS LLC
NPI 1982065983
Clinic/Center - Primary Care in Minneapolis, MN
About Dagan Wellness Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DAGAN WELLNESS LLC (NPI 1982065983), doing business as Lake Clinic, is a healthcare organization registered as a primary care in Minneapolis, Minnesota and active in the NPI registry since March 2016. The organization holds a CLIA Waiver certificate valid through October 17, 2027 and lists Jacquelyn Lee Denardo, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dagan Wellness Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Dagan Wellness LLC, 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 (2)
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 24D2173764
Dagan Wellness LLC, Dba ( Lake Clinic) · Minneapolis, MNFrequently 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 Dagan Wellness LLC's NPI number?
The NPI number for Dagan Wellness LLC is 1982065983. It was assigned to this organization in the NPPES registry on March 17, 2016. The provider is doing business as Lake Clinic.
Where is Dagan Wellness LLC located?
Dagan Wellness LLC is located at 311 W Lake St, Minneapolis, MN 55408. The listed phone number is (952) 210-7996.
What is Dagan Wellness LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Primary Care, with taxonomy code 261QP2300X.
Is Dagan Wellness LLC enrolled in Medicare?
Yes. Dagan Wellness LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Dagan Wellness LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Dagan Wellness LLC. 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 Dagan Wellness LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 24D2173764) is associated with this NPI, valid through October 17, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Dagan Wellness LLC was last updated on June 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.
# Dagan Wellness Llc · NPI 1982065983
Primary Care organization in Minneapolis, Minnesota. Organization record, active in the CMS NPPES registry since March 17, 2016.
## Identity
- **NPI:** 1982065983 (Entity type: Organization)
- **Enumerated:** March 17, 2016
- **Primary specialty:** Clinic/Center - Primary Care · taxonomy 261QP2300X
- **Also known as:** LAKE CLINIC (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Jacquelyn Denardo, OWNER
## Practice location
- **Address:** 311 W LAKE ST, Minneapolis, MN 55408-3026
- **Phone:** (952) 210-7996
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** June 5, 2025
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1982065983) · Data from the CMS NPPES public registry.