NPIMap

Organization Active NPI

Forest County Potawatomi Health & Wellness Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Crandon, WI
National Provider Identifier
1376650499
Registry record updated Dec 9, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Practice address
8201 Mish Ko Swen Dr
Crandon, WI 54520-8631
Phone
(715) 478-4300
Fax
(715) 478-4490
NPI assigned
Aug 24, 2006
Last updated
Dec 9, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2020

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

Authorized official

Name
Mr. Ned Daniels
Title
Tribal Chairman
Phone
(715) 478-4824

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU Primary
Adult Mental Health Clinic/Center 261QM0850X NU
Adolescent and Children Mental Health Clinic/Center 261QM0855X NU
Addiction (Substance Use Disorder) Counselor 101YA0400X NU

Addresses

Primary practice location

8201 Mish Ko Swen Dr
Crandon, WI 54520-8631

Mailing address

PO Box 396
8201 Mish Ko Swen Drive
Crandon, WI 54520-0396
Phone (715) 478-4300

Other identifiers 1

IdentifierTypeStateIssuer
42182600MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040228000204 WI Part B Supplier - Clinic/Group Practice 3375454689 Receives reassigned benefits from 28 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Crandon, WI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Forest Co Potawatomi Co3 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8439/brand/1/csg/21/fhir/r4

Practitioners & affiliated clinicians

Practitioners 15

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 15

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607472000000",
    "number": "1376650499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 396",
            "address_2": "8201 MISH KO SWEN DRIVE",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545200396",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8201 MISH KO SWEN DR",
            "city": "CRANDON",
            "state": "WI",
            "postal_code": "545208631",
            "telephone_number": "715-478-4300",
            "fax_number": "715-478-4490"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-12-09",
        "certification_date": "2020-12-09",
        "status": "A",
        "authorized_official_last_name": "DANIELS",
        "authorized_official_first_name": "NED",
        "authorized_official_title_or_position": "TRIBAL CHAIRMAN",
        "authorized_official_telephone_number": "715-478-4824",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0855X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adolescent and Children Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42182600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crandon, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 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.

Verify at the official NPI Registry.