Family Health/La Clinica – Federally Qualified Health Center (FQHC), NPI 1790786929
Federally Qualified Health Center (FQHC)
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Family Health/La Clinica
302 W Lake St
Friendship, WI 539349698
Phone: (800) 942-5330
Fax: (608) 474-4309
Type: Location
207 S University Ave
Beaver Dam, WI 539162450
Phone: (920) 356-5012
Fax: (920) 273-3169
Type: Location
1701 N Spring St
Beaver Dam, WI 539161178
Phone: (920) 644-0317
Fax: (920) 644-0318
Type: Location
880 Herriot Dr
Mauston, WI 539482031
Phone: (608) 847-6700
Fax: (608) 847-6122
Type: Location
400 S Townline Rd
Wautoma, WI 549826922
Phone: (920) 787-5514
Fax: (920) 787-4737
Type: Location
PO BOX 1440
WAUTOMA, WI 549821440
Phone: (920) 787-5514
Fax: (920) 787-4737
Type: Mailing
3125 MAIN ST
STEVENS POINT, WI 544813269
Phone: (715) 254-9072
Fax: (715) 254-9106
Type: Location
2501 MAIN ST
STEVENS POINT, WI 544814000
Phone: (715) 254-9072
Fax: (715) 254-9106
Type: Location
South Townline Road, Wautoma, Waushara County, Wisconsin, 54982, United States
WAUTOMA, WI 549826922
Phone: (920) 787-5514
Fax: (920) 787-4737
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2024-03-15
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-07-31 (1045 days ago).
Enrollment records
5
Earliest due date
2023-07-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20030331000042 | O | Federally Qualified Health Center (Fqhc) | WI | TBD |
| O20040806000058 | O | Clinic/Group Practice | WI | TBD |
| O20180718000361 | O | Federally Qualified Health Center (Fqhc) | WI | 2023-07-31 |
| O20230620002007 | O | Federally Qualified Health Center (Fqhc) | WI | TBD |
| O20240315000308 | O | Federally Qualified Health Center (Fqhc) | WI | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 53934)
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