NPIMap

Organization Active NPI

Grand Traverse Band of Ottawa and Chippewa Indians

Doing business as Grand Traverse Band Family Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Suttons Bay, MI
National Provider Identifier
1134281132
Registry record updated Feb 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Doing business as
Grand Traverse Band Family Health Clinic
Practice address
2300 N Stallman Rd Ste a
Suttons Bay, MI 49682-9158
Phone
(231) 534-7200
Fax
(231) 534-7460
NPI assigned
Dec 15, 2006
Last updated
Feb 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2025

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

Authorized official

Name
Sonya Zotigh
Title
Health Admin
Phone
(231) 534-7241

Specialties & licenses 1

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

Addresses

Primary practice location

2300 N Stallman Rd Ste a
Suttons Bay, MI 49682-9158

Mailing address

2300 N Stallman Rd Ste a
Suttons Bay, MI 49682-9158
Phone (231) 534-7200

Other identifiers 2

IdentifierTypeStateIssuer
700D545020OtherMIBCBS
1376553586MedicaidMI

Other names 1

  • Grand Traverse Band Family Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040911000198 MI Part B Supplier - Clinic/Group Practice 5193792067 Receives reassigned benefits from 7 practitioners
Practice locations: Peshawbestown, MI
O20100908000362 MI Part A Provider - Federally Qualified Health Center (FQHC) 5193792067 Practice locations: Suttons Bay, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134281132. Details of each certification follow.

Federally qualified health center certification: CCN 231844

Legal name
GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
2300 N Stallman Rd
Ste a
Suttons Bay, MI 49682-9158

National Provider Directory

National Provider Directory

Locations

2300 N Stallman Rd
Suttons Bay, MI 49682
Phone (231) 534-7200

2300 N Stallman Rd
#A
Suttons Bay, MI 49682
Phone (231) 534-7200

2605 N West Bay Shore Dr
Suttons Bay, MI 49682
Phone (231) 271-6006

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Darylin Sue Berryman Individual W-2 Managing EmployeeCredentialing Specialist May 1, 2024 100%
Sonya L Zotigh Individual Corporate DirectorHealth Director Aug 29, 2024 100%
W-2 Managing EmployeeMD; Aug 29, 2024 100%
Grand Traverse Band of Ottawa and Chippewa Indians Organization, Peshawbestown, MI 5% Or Greater Direct Ownership Interest Oct 1, 1991 100%

Practitioners & affiliated clinicians

Practitioners 16

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 16

NPI Registry JSON

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

{
    "created_epoch": "1166140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1739232000000",
    "number": "1134281132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN RD STE A",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829158",
            "telephone_number": "231-534-7200",
            "fax_number": "231-534-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN RD STE A",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829158",
            "telephone_number": "231-534-7200",
            "fax_number": "231-534-7460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE BAND OF OTTAWA AND CHIPPEWA INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-15",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A",
        "authorized_official_last_name": "ZOTIGH",
        "authorized_official_first_name": "SONYA",
        "authorized_official_title_or_position": "HEALTH ADMIN",
        "authorized_official_telephone_number": "231-534-7241"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "700D545020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1376553586",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Traverse Band Family Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suttons Bay, MI

Sources for this page

Verify at the official NPI Registry.