NPIMap

Organization Active NPI

Red Cliff Band of Lake Superior Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Bayfield, WI
National Provider Identifier
1497744015
Registry record updated Feb 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
32956200 Issued in WI
Legal business name
RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS
Practice address
36745 Aiken Rd
Bayfield, WI 54814-4579
Phone
(715) 779-3707
Fax
(715) 779-3362
NPI assigned
Oct 17, 2005
Organization subpart
Yes
Parent organization
RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 24, 2023

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

Authorized official

Name
Ms. Diane Erickson
Title
Health Services Administrator
Phone
(715) 779-3707

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YA0400X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X WI
Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163W00000X WI
PharmacistGroup: 193200000X MULTI-SPECIALTY GROUP 183500000X
Dental Clinic/Center 261QD0000X
Federally Qualified Health Center (FQHC) 261QF0400X 32956200 WI Primary
Primary Care Clinic/Center 261QP2300X
Durable Medical Equipment & Medical Supplies 332B00000X WI
Ambulance 341600000X WI

Addresses

Primary practice location

36745 Aiken Rd
Bayfield, WI 54814-4579

Mailing address

36745 Aiken Rd
Bayfield, WI 54814-4579
Phone (715) 779-3707

Other identifiers 4

IdentifierTypeStateIssuer
CS3144OtherRR RETIREMENT PALMETTO
32956200MedicaidWI
44004200MedicaidWI
10170-001OtherGROUP PLAN # DENTAL

Other names 1

  • Red Cliff Community Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040202000406 WI Part B Supplier - Clinic/Group Practice 4284537580 Receives reassigned benefits from 20 practitioners
Practice locations: Bayfield, WI

Other NPIs with the same Medicare PAC ID 1

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

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
52D0855724Red Cliff Community Health Center36745 Aiken Rd, Bayfield, WI 54814ComplianceFeb 27, 2027

National Provider Directory

National Provider Directory
Part of
Red Cliff Trib Amb Ser

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 21

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

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677196800000",
    "number": "1497744015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36745 AIKEN RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144579",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36745 AIKEN RD",
            "city": "BAYFIELD",
            "state": "WI",
            "postal_code": "548144579",
            "telephone_number": "715-779-3707",
            "fax_number": "715-779-3362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "RED CLIFF BAND OF LAKE SUPERIOR CHIPPEWA INDIANS",
        "enumeration_date": "2005-10-17",
        "last_updated": "2023-02-24",
        "certification_date": "2023-02-24",
        "status": "A",
        "authorized_official_last_name": "ERICKSON",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "HEALTH SERVICES ADMINISTRATOR",
        "authorized_official_telephone_number": "715-779-3707",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pharmacist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WI",
            "license": "32956200",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "341600000X",
            "taxonomy_group": "",
            "desc": "Ambulance",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR RETIREMENT PALMETTO",
            "identifier": "CS3144",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32956200",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44004200",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP PLAN # DENTAL",
            "identifier": "10170-001",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Cliff Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Red Cliff Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bayfield, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.