OrganizationActive
Random Lake Spine & Sports Clinic
NPI 1659543205 · Clinic/Center · Random Lake, WI
Provider details
- NPI number
- 1659543205
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Jason Rudelich, President(920) 994-2000
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
Detailed profile(87/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
18 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
321 Carroll St.
Random Lake, WI 53075
Phone: (920) 994-2000
Street-level locationGet directions
Mailing address
Po Box 196
Random Lake, WI 53075-0196
Registry dates
- Enumerated
- 2008-03-24
- Last updated
- 2008-06-02
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.