NPIMap

Organization Active NPI

Kalispel Indian Community of the Kalispel Reservation Washington

  • General Practice Physician
  • Cusick, WA
National Provider Identifier
1396937769
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON
Practice address
1821 Leclerc Rd N
Cusick, WA 99119-9682
Phone
(509) 447-7111
NPI assigned
Aug 9, 2007
Last updated
Dec 16, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Authorized official

Name
Dr. Clayton Kersting, M.D.NPI 1962594234
Title
Director of Medical Services
Phone
(509) 447-7111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Service Clinic/Center 261QH0100X
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

1821 Leclerc Rd N
Cusick, WA 99119-9682

Mailing address

PO Box 67
Cusick, WA 99119-0067
Phone (509) 447-7111

Other names 1

  • Camas Center for Community Wellness Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071107000736 WA Part B Supplier - Clinic/Group Practice 1951498922 Receives reassigned benefits from 15 practitioners
1 other NPI on this enrollment
Practice locations: Airway Heights, WA; Cusick, WA

Other NPIs with the same Medicare PAC ID 1

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

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

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": "1186617600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765843200000",
    "number": "1396937769",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67",
            "city": "CUSICK",
            "state": "WA",
            "postal_code": "991190067",
            "telephone_number": "509-447-7111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 LECLERC RD N",
            "city": "CUSICK",
            "state": "WA",
            "postal_code": "991199682",
            "telephone_number": "509-447-7111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALISPEL INDIAN COMMUNITY OF THE KALISPEL RESERVATION WASHINGTON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-09",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A",
        "authorized_official_last_name": "KERSTING",
        "authorized_official_first_name": "CLAYTON",
        "authorized_official_title_or_position": "DIRECTOR OF MEDICAL SERVICES",
        "authorized_official_telephone_number": "509-447-7111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Camas Center for Community Wellness",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Camas Center for Community Wellness",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cusick, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; 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.