NPIMap

Organization Active NPI

Sisseton Wahpeton Oyate of the Lake Traverse Reservation

  • Community Health Worker
  • Agency Village, SD
National Provider Identifier
1073330064
Registry record updated Sep 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health WorkerTaxonomy code 172V00000X
Legal business name
SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION
Practice address
12554 Bia Highway 711
Agency Village, SD 57262-7409
Phone
(605) 698-3911
NPI assigned
Sep 23, 2024
Last updated
Sep 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2024

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

Authorized official

Name
Elise Johnson
Title
Tribal Health Director
Phone
(605) 698-8315

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Worker 172V00000X Primary

Addresses

Primary practice location

12554 Bia Highway 711
Agency Village, SD 57262-7409

Mailing address

PO Box 509
Agency Village, SD 57262-0509
Phone (605) 698-3911

Other practice location 1

301 Tiospa Zina Drive
Agency Viillage, SD 57262
Phone (605) 698-3922

Other practice location 2

114 Lake Traverse Dr
Sisseton, SD 57262-7046
Phone (605) 419-1116

National Provider Directory

National Provider Directory
Tax ID family
Sisseton Wahpeton Oyate of the Lake Traverse Reservation7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

114 Lake Traverse Dr
Sisseton, SD 57262
Phone (605) 419-1116

NPI Registry JSON

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

{
    "created_epoch": "1727049600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727049600000",
    "number": "1073330064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 509",
            "city": "AGENCY VILLAGE",
            "state": "SD",
            "postal_code": "572620509",
            "telephone_number": "605-698-3911"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12554 BIA HIGHWAY 711",
            "city": "AGENCY VILLAGE",
            "state": "SD",
            "postal_code": "572627409",
            "telephone_number": "605-698-3911"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Tiospa Zina Drive",
            "address_purpose": "LOCATION",
            "city": "Agency Viillage",
            "state": "SD",
            "postal_code": "57262",
            "country_code": "US",
            "telephone_number": "605-698-3922",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "114 Lake Traverse Dr",
            "address_purpose": "LOCATION",
            "city": "Sisseton",
            "state": "SD",
            "postal_code": "572627046",
            "country_code": "US",
            "telephone_number": "605-419-1116",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SISSETON WAHPETON OYATE OF THE LAKE TRAVERSE RESERVATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-23",
        "last_updated": "2024-09-23",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "ELISE",
        "authorized_official_title_or_position": "TRIBAL HEALTH DIRECTOR",
        "authorized_official_telephone_number": "605-698-8315"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Agency Village, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.