NPIMap

Organization Active NPI

Pokagon Band of Potawatomi Indians

Doing business as Pokagon Health Service

  • Federally Qualified Health Center (FQHC)
  • Dowagiac, MI
National Provider Identifier
1497833271
Registry record updated Jan 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
POKAGON BAND OF POTAWATOMI INDIANS
Doing business as
Pokagon Health Service
Practice address
32652 Kno Drive
Dowagiac, MI 49047-0180
Phone
(269) 782-4141
Fax
(269) 783-1236
NPI assigned
Nov 1, 2006
Last updated
Jan 11, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2021

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

Authorized official

Name
Priscilla Gatties
Title
Director of Health Services
Phone
(269) 782-4141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

32652 Kno Drive
Dowagiac, MI 49047-0180

Mailing address

PO Box 180
Dowagiac, MI 49047-0180
Phone (269) 782-4141

Other practice location 1

1986 Mall Pl
Benton Harbor, MI 49022-2332
Phone (269) 945-5858

Other names 2

  • Pokagon Health Service Doing business as
  • Mshkiki Community Clinic Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040121001135 TX Part B Supplier - Clinic/Group Practice 3476455445 Receives reassigned benefits from 22 practitioners
Practice locations: Benton Harbor, MI; Dowagiac, MI

National Provider Directory

National Provider Directory

Locations

3733 S Locust Rd
South Bend, IN 46614

114 Commercial St
Fl 2
Dowagiac, MI 49047
Phone (269) 462-9464

32652 Kno
Dowagiac, MI 49047
Phone (269) 782-4141

57392 M 51 S
Dowagiac, MI 49047
Phone (269) 462-9587

58620 Sink Rd
Dowagiac, MI 49047
Phone (269) 782-4141

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610323200000",
    "number": "1497833271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 180",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490470180",
            "telephone_number": "269-782-4141",
            "fax_number": "269-783-1236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "32652 KNO DRIVE",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490470180",
            "telephone_number": "269-782-4141",
            "fax_number": "269-783-1236"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1986 Mall Pl",
            "address_purpose": "LOCATION",
            "city": "Benton Harbor",
            "state": "MI",
            "postal_code": "490222332",
            "country_code": "US",
            "telephone_number": "269-945-5858",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "POKAGON BAND OF POTAWATOMI INDIANS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2021-01-11",
        "certification_date": "2021-01-11",
        "status": "A",
        "authorized_official_last_name": "GATTIES",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_title_or_position": "DIRECTOR OF HEALTH SERVICES",
        "authorized_official_telephone_number": "269-782-4141"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pokagon Health Service",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mshkiki Community Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dowagiac, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2021; 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.