NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committee

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Cloquet, MN
National Provider Identifier
1053772087
Registry record updated Jun 23, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Practice address
927 Trettel LN
Cloquet, MN 55720-1345
Phone
(218) 879-1227
NPI assigned
Mar 18, 2016
Organization subpart
Yes
Parent organization
FOND DU LAC HUMAN SERVICES DIVISIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2020

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

Authorized official

Name
Jennifer Dupuis
Title
Associate Director
Phone
(218) 879-1227

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X Primary

Addresses

Primary practice location

927 Trettel LN
Cloquet, MN 55720-1345

Mailing address

927 Trettel LN
Cloquet, MN 55720-1345
Phone (218) 879-1227

Other identifiers 3

IdentifierTypeStateIssuer
666815101MedicaidMN
8F27FOOtherMNBCBS AODA
666815100MedicaidMN

Other names 1

  • FDL Human Services Behavioral Health Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040107000308 MN Part B Supplier - Clinic/Group Practice 6608775879 Receives reassigned benefits from 70 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cloquet, MN; Duluth, MN

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
FDL Adolescent Outpatient TX8 organizations share this tax ID, including this one
Part of
FDL Adolescent Outpatient TX

Other organizations with this tax ID 7

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

Locations

211 W 4th St
Duluth, MN 55806
Phone (218) 726-1370

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1458259200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592870400000",
    "number": "1053772087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LN",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201345",
            "telephone_number": "218-879-1227"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LN",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201345",
            "telephone_number": "218-879-1227"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOND DU LAC HUMAN SERVICES DIVISION",
        "enumeration_date": "2016-03-18",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A",
        "authorized_official_last_name": "DUPUIS",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "218-879-1227"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666815101",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS AODA",
            "identifier": "8F27FO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "666815100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FDL Human Services Behavioral Health",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "FDL Human Services Behavioral Health",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; 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.