NPIMap

Organization Active NPI

Bois Forte Reservation Tribal Government

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Nett Lake, MN
National Provider Identifier
1073530150
Registry record updated May 19, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
BOIS FORTE RESERVATION TRIBAL GOVERNMENT
Practice address
5219 St. John Dr
Nett Lake, MN 55772
Phone
(218) 757-3650
NPI assigned
Jul 16, 2006
Last updated
May 19, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 19, 2022

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

Authorized official

Name
Catherine Chavers
Title
Tribal Chairman
Phone
(218) 757-3361

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X
Home Delivered Meals 332U00000X
Respite Care 385H00000X
Family Medicine Physician 207Q00000X
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

5219 St. John Dr
Nett Lake, MN 55772

Mailing address

5219 Saint John Dr
Orr, MN 55771-8232
Phone (218) 757-3650

Other identifiers 2

IdentifierTypeStateIssuer
63G35BOOtherMNBCBS
177515400MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000284 MN Part B Supplier - Clinic/Group Practice 7517879778 Receives reassigned benefits from 9 practitioners
3 other NPIs on this enrollment
Practice locations: Orr, MN; Tower, MN

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory

Locations

13071 Nett Lake Rd
Orr, MN 55771
Phone (218) 757-3295

Practitioners & affiliated clinicians

Practitioners 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1073530150",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5219 SAINT JOHN DR",
            "city": "ORR",
            "state": "MN",
            "postal_code": "557718232",
            "telephone_number": "218-757-3650",
            "fax_number": "218-757-0222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5219 ST. JOHN DR",
            "city": "NETT LAKE",
            "state": "MN",
            "postal_code": "55772",
            "telephone_number": "218-757-3650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOIS FORTE RESERVATION TRIBAL GOVERNMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-16",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "CHAVERS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_title_or_position": "TRIBAL CHAIRMAN",
        "authorized_official_telephone_number": "218-757-3361"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332U00000X",
            "taxonomy_group": "",
            "desc": "Home Delivered Meals",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385H00000X",
            "taxonomy_group": "",
            "desc": "Respite Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "63G35BO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "177515400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Nett Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; 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.