NPIMap

Organization Active NPI

Reno Sparks Indian Colony

  • Clinic/Center
  • Reno, NV
National Provider Identifier
1497700801
Registry record updated May 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
RENO SPARKS INDIAN COLONY
Practice address
1715 Kuenzli Street
Reno, NV 89502-1117
Phone
(775) 329-5162
Fax
(775) 334-4350
NPI assigned
May 23, 2006
Organization subpart
Yes
Parent organization
RENO SPARKS INDIAN COLONY DBA RENO SPARKS TRIBAL HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 24, 2012

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

Authorized official

Name
Mr. Elvin Willie
Title
Acting Clinic Director
Phone
(775) 329-5162

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Clinic/Center 261Q00000X NV Primary

Addresses

Primary practice location

1715 Kuenzli Street
Reno, NV 89502-1117

Mailing address

1715 Kuenzli Street
Reno, NV 89502-1117
Phone (775) 329-5162

Other identifiers 2

IdentifierTypeStateIssuer
004716904MedicaidNV
003116904MedicaidNV

Other names 1

  • reno sparks tribal health center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031201000208 NV Part B Supplier - Clinic/Group Practice 6507761897 Receives reassigned benefits from 10 practitioners
Practice locations: Reno, NV
O20191009000361 TX Part B Supplier - Clinic/Group Practice 6507761897 Receives reassigned benefits from 18 practitioners
Practice locations: Reno, NV

National Provider Directory

National Provider Directory
Part of
Reno Sparks Indian Colony

Locations

34 Reservation Rd
Reno, NV 89502
Phone (775) 329-5162

1715 Kuenzli St
#100
Reno, NV 89502

Practitioners & affiliated clinicians

Practitioners 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1337817600000",
    "number": "1497700801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1715 KUENZLI STREET",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021117",
            "telephone_number": "775-329-5162",
            "fax_number": "775-334-4350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1715 KUENZLI STREET",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895021117",
            "telephone_number": "775-329-5162",
            "fax_number": "775-334-4350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RENO SPARKS INDIAN COLONY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RENO SPARKS INDIAN COLONY DBA RENO SPARKS TRIBAL HEALTH CENTER",
        "enumeration_date": "2006-05-23",
        "last_updated": "2012-05-24",
        "status": "A",
        "authorized_official_last_name": "WILLIE",
        "authorized_official_first_name": "ELVIN",
        "authorized_official_title_or_position": "ACTING CLINIC DIRECTOR",
        "authorized_official_telephone_number": "775-329-5162",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004716904",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003116904",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "reno sparks tribal health center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Reno, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2012; 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.