Active NPI
Spirit Lake Tribe
Doing business as Spirit Lake Health Center
- Health Service Clinic/Center
- Fort Totten, ND
National Provider Identifier
1114472891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Health Service Clinic/Center
- Legal business name
- SPIRIT LAKE TRIBE
- Doing business as
- Spirit Lake Health Center
- Practice address
- 3883 74TH Ave NE
Fort Totten, ND 58335 - Phone
- (701) 766-1600
- Fax
- (701) 766-1630
- NPI assigned
- Aug 23, 2016
- Last updated
- Apr 7, 2020
- Organization subpart
- Yes
- Parent organization
- SPIRIT LAKE TRIBE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Arlene Krulish
- Title
- Ceo
- Phone
- (701) 766-1607
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Primary | ||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Podiatric Clinic/Center | 261QP1100X | |||
| Mammography Clinic/Center | 261QR0206X | |||
| Clinical Medical Laboratory | 291U00000X |
Addresses
Primary practice location
3883 74TH Ave NE
Fort Totten, ND 58335
Mailing address
PO Box 309
Fort Totten, ND 58335-0309
Phone (701) 766-1600
Other names 1
- Spirit Lake Health Center
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | ftc@directihs.net | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20161206002392 | TX | Part B Supplier - Clinic/Group Practice | 2466550801 |
Receives reassigned benefits from 26 practitioners Practice locations: Fort Totten, ND |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
National Provider Directory
National Provider Directory- Part of
- Spirit Lake Okiciyapi
Interoperability endpoints
- ftc@directihs.net
Practitioners & affiliated clinicians
Practitioners 77
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.
-
- Addiction (Substance Use Disorder) Counselor
- Devils Lake, ND
- NPI 1912399262
TX
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1471910400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1586217600000",
"number": "1114472891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 309",
"city": "FORT TOTTEN",
"state": "ND",
"postal_code": "583350309",
"telephone_number": "701-766-1600",
"fax_number": "701-766-1630"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3883 74TH AVE NE",
"city": "FORT TOTTEN",
"state": "ND",
"postal_code": "58335",
"telephone_number": "701-766-1600",
"fax_number": "701-766-1630"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SPIRIT LAKE TRIBE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SPIRIT LAKE TRIBE",
"enumeration_date": "2016-08-23",
"last_updated": "2020-04-07",
"certification_date": "2020-04-07",
"status": "A",
"authorized_official_last_name": "KRULISH",
"authorized_official_first_name": "ARLENE",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "701-766-1607"
},
"taxonomies": [
{
"code": "261QH0100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Health Service",
"state": null,
"license": null,
"primary": true
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QP1100X",
"taxonomy_group": "",
"desc": "Clinic/Center, Podiatric",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QR0206X",
"taxonomy_group": "",
"desc": "Clinic/Center, Radiology, Mammography",
"state": null,
"license": null,
"primary": false
},
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "ftc@directihs.net",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "3883 74th Ave",
"city": "Fort Totten",
"state": "ND",
"country_code": "US",
"postal_code": "58335",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"organization_name": "Spirit Lake Health Center",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Spirit Lake Health Center",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Fort Totten, ND
- Spirit Lake Tribe (Dakotah Health & Wellness Transportation)
- Spirit Lake Tribe (Spirit Lake EMS)
- Spirit Lake Tribe
- Spirit Lake Tribe (Spirit Lake Health Center)
- Spirit Lake Tribe (Spirit Lake Tribe Tiwahe Program)
- Spirit Lake Tribe (Spirit Lake Health Center)
- Spirit Lake Tribe
- Spirit Lake Tribe (Spirit Lake Health Center)
- Spirit Lake Tribe (Spirit Lake Health Center Pharmacy)
- Spirit Lake Tribe (Spirit Lake Health Center)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.