NPIMap

Organization Active NPI

Bay Mills Indian Community

  • Land Ambulance
  • Brimley, MI
National Provider Identifier
1326005273
Registry record updated Nov 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
License
4704182384 Issued in MI
Legal business name
BAY MILLS INDIAN COMMUNITY
Practice address
3406 S Pine Village Rd
Brimley, MI 49715-9324
Phone
(906) 248-2021
Fax
(906) 248-2023
NPI assigned
Apr 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2022

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

Authorized official

Name
Audrey Breakie
Title
HHS Director
Phone
(906) 248-8327

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X 4704182384 MI Primary

Addresses

Primary practice location

3406 S Pine Village Rd
Brimley, MI 49715-9324

Mailing address

12455 W Lakeshore Dr
Brimley, MI 49715-9327
Phone (906) 248-5527

Other identifiers 5

IdentifierTypeStateIssuer
590015176OtherMEDICARE RAILROAD
209255OtherMULTI-PLAN
1326005273MedicaidMI
590A700080OtherBLUE CROSS BLUE SHIELD
900020355OtherPRIORITY HEALTH

Other names 1

  • BAY MILLS EMERGENCY CONNECTION Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120824000045 MI Part B Supplier - Ambulance Service Supplier 8729079918 Practice locations: Brimley, MI

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Bay Mills Health Center10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Locations

3466 S Pine Village Rd
Brimley, MI 49715
Phone (906) 248-8261

Ownership & related parties

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Bay Mills Indian CommunityBrimley, MI, CCN 231839 Federally qualified health center Operational/Managerial Control Jan 1, 1993
Bay Mills Indian CommunitySault Sainte Marie, MI, CCN C71010 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Dec 13, 2023

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669680000000",
    "number": "1326005273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12455 W LAKESHORE DR",
            "city": "BRIMLEY",
            "state": "MI",
            "postal_code": "497159327",
            "telephone_number": "906-248-5527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3406 S PINE VILLAGE RD",
            "city": "BRIMLEY",
            "state": "MI",
            "postal_code": "497159324",
            "telephone_number": "906-248-2021",
            "fax_number": "906-248-2023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY MILLS INDIAN COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2022-11-29",
        "certification_date": "2022-11-29",
        "status": "A",
        "authorized_official_last_name": "BREAKIE",
        "authorized_official_first_name": "AUDREY",
        "authorized_official_title_or_position": "HHS DIRECTOR",
        "authorized_official_telephone_number": "906-248-8327"
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "MI",
            "license": "4704182384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "590015176",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MULTI-PLAN",
            "identifier": "209255",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326005273",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "590A700080",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "900020355",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BAY MILLS EMERGENCY CONNECTION",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "BAY MILLS EMERGENCY CONNECTION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brimley, MI

Sources for this page

Verify at the official NPI Registry.