NPIMap

Organization Active NPI

White Earth Band of Chippewa

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • White Earth, MN
National Provider Identifier
1174944110
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
WHITE EARTH BAND OF CHIPPEWA
Practice address
26246 Crane Rd
White Earth, MN 56591-9998
Phone
(218) 983-3286
NPI assigned
Dec 18, 2013
Organization subpart
Yes
Parent organization
WHITE EARTH BAND OF CHIPPEWAAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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

Authorized official

Name
Erma Vizenor
Title
Tribal Chairwoman
Phone
(218) 983-3286

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X Primary

Addresses

Primary practice location

26246 Crane Rd
White Earth, MN 56591-9998

Mailing address

PO Box 327
26246 Crane Rd
White Earth, MN 56591-0327
Phone (218) 983-3286

Other names 1

  • White Earth Dialysis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140422001223 MN Part A Provider - End-Stage Renal Disease Facility (ESRD) 7315993995 Practice locations: White Earth, MN

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
White Earth DialysisCCN 242592
Overall star rating
4.0 of 5
Ownership
Profit
Certified
Aug 12, 2014
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
8

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2082111White Earth Dialysis26246 Crane Road, White Earth, MN 56591Certificate of waiverAug 6, 2026

National Provider Directory

National Provider Directory
Tax ID family
White Earth Oshki Manidoo New Spirit Center26 organizations share this tax ID, including this one
Part of
White Earth Oshki Manidoo New Spirit Center

Other organizations with this tax ID 25

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

View all 25

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
White Earth Home Health AgencyWhite Earth, MN, CCN 247096 Home health agency 5% Or Greater Direct Ownership Interest (100%) Dec 1, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1387324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1174944110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 327",
            "address_2": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565910327",
            "telephone_number": "218-983-3286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565919998",
            "telephone_number": "218-983-3286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE EARTH BAND OF CHIPPEWA",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WHITE EARTH BAND OF CHIPPEWA",
        "enumeration_date": "2013-12-18",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "VIZENOR",
        "authorized_official_first_name": "ERMA",
        "authorized_official_title_or_position": "TRIBAL CHAIRWOMAN",
        "authorized_official_telephone_number": "218-983-3286"
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Earth Dialysis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in White Earth, MN

Sources for this page

Verify at the official NPI Registry.