NPIMap

Organization Active NPI

Sokaogon Chippewa Community

  • Federally Qualified Health Center (FQHC)
  • Crandon, WI
National Provider Identifier
1033115456
Registry record updated Mar 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
32957000 Issued in WI
Legal business name
SOKAOGON CHIPPEWA COMMUNITY
Practice address
3144 Vanzile Rd
Crandon, WI 54520-8149
Phone
(715) 478-5180
Fax
(715) 478-5904
NPI assigned
Jun 21, 2005
Last updated
Mar 25, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Chris McGeshick
Title
Clinic Director
Phone
(715) 478-5180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 32957000 WI Primary

Addresses

Primary practice location

3144 Vanzile Rd
Crandon, WI 54520-8149

Mailing address

3144 Vanzile Rd
Crandon, WI 54520-8149
Phone (715) 478-5180

Other identifiers 1

IdentifierTypeStateIssuer
32957000MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040512000238 WI Part B Supplier - Clinic/Group Practice 1759370869 Receives reassigned benefits from 14 practitioners
Practice locations: Crandon, WI
O20201124002961 WI Part B Supplier - Pharmacy 1759370869 Practice locations: Crandon, WI

National Provider Directory

National Provider Directory
Tax ID family
Sokaogon Chippewa Community2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

3144 Vanzile Rd
Crandon, WI 54520
Phone (715) 478-5180

3163 State Highway 55
Crandon, WI 54520
Phone (715) 478-5180

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73753

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742860800000",
    "number": "1033115456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3144 VANZILE RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208149",
            "telephone_number": "715-478-5180",
            "fax_number": "715-478-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3144 VANZILE RD",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208149",
            "telephone_number": "715-478-5180",
            "fax_number": "715-478-5904"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOKAOGON CHIPPEWA COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2025-03-25",
        "certification_date": "2025-03-25",
        "status": "A",
        "authorized_official_last_name": "MCGESHICK",
        "authorized_official_first_name": "CHRIS",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "715-478-5180"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WI",
            "license": "32957000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32957000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crandon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.