Crystal Lake Clinic PC
NPI 1134491731 · Family Medicine Physician · Manistee, MI
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Crystal Lake Clinic PC is a Family Medicine Physician organization in Manistee, MI (NPI 1134491731).
Provider details
- NPI number
- 1134491731
- Entity type
- Organization
- Primary specialty
- Family Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Richard Nielsen, President(231) 882-9661
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
14 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Registry dates
- Enumerated
- 2012-01-30
- Last updated
- 2012-01-30
Frequently asked questions
- What is Crystal Lake Clinic PC's NPI number?
- Crystal Lake Clinic PC's National Provider Identifier (NPI) is 1134491731, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Crystal Lake Clinic PC?
- Crystal Lake Clinic PC is classified in the NPPES registry as Family Medicine Physician (Allopathic & Osteopathic Physicians).
- Where is Crystal Lake Clinic PC located?
- Crystal Lake Clinic PC's practice location on file with NPPES is 1806 E Parkdale Ave Ste 2, Manistee, MI 49660-9364.
- What is Crystal Lake Clinic PC's phone number?
- The practice phone number listed in the NPPES registry for Crystal Lake Clinic PC is (231) 882-9661.
- Does Crystal Lake Clinic PC accept Medicare?
- Crystal Lake Clinic PC is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Crystal Lake Clinic PC?
- The authorized official listed on Crystal Lake Clinic PC's NPPES record is Richard Nielsen, President. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Crystal Lake Clinic PC's NPI active?
- Yes — Crystal Lake Clinic PC's NPI (1134491731) is active in the NPPES registry as of the last update on 2012-01-30.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.