Crystal Lake Clinic PC
NPI 1134491731ActiveOrganization· Family Medicine· Manistee, MI
Family Medicine in Manistee, Michigan, registered in NPPES in January 2012. The authorized official on file is Richard Nielsen, M.D., President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1134491731 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 30, 2012 |
| Last updated in NPPES | Jan 30, 2012 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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