Pokagon Band of Potawatomi Indians
Organization Active NPI Federally Qualified Health Center (FQHC) · Dowagiac, MI
NPI 1497833271 · NPPES record last updated Jan 11, 2021
Key facts
- NPI
- 1497833271
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- POKAGON BAND OF POTAWATOMI INDIANS
- Practice address
- 32652 Kno Drive
Dowagiac, MI 49047-0180 - Phone
- (269) 782-4141
- Fax
- (269) 783-1236
- NPI assigned
- Nov 1, 2006
- Organization subpart
- No
Authorized official
- Name
- Priscilla Gatties
- Title
- Director of Health Services
- Phone
- (269) 782-4141
Practitioners 32
-
Delphine Colar, DO
-
Andrew A Dehaven, D.C.
-
Brian D Hoffman, D.C.
-
Marcy Parisi, NP
-
Gregory S Wallin, MD
-
Jennifer Ervin, LMHC, LPC
-
Misty Rae Ledesma, NP-C
-
Matthew Veenstra, D.D.S.
-
Joo-Youn Yi, D.D.S.
-
Cynthia J Grate, LCSW
-
Sacheen Shrestha, M.D.
-
Eric J Chamberlin, MSW
-
Shanta Lynn Clark, P.A.-C
-
Patrick M Loughlin, MSW
-
Victoria C Johnson, LLPC, NCE
-
Eunkyoung Diane E Lee, D.D.S
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
3733 S Locust Rd
South Bend, IN 46614
1986 Mall Pl
Benton Harbor, MI 49022
Phone (269) 945-5854
114 Commercial St
Fl 2
Dowagiac, MI 49047
Phone (269) 462-9464
58620 Sink Rd
Dowagiac, MI 49047
Phone (269) 782-4141
32652 Kno
Dowagiac, MI 49047
Phone (269) 782-4141
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
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
- Pokagon Health Service
- Mshkiki Community Clinic
Other providers in Dowagiac, MI
- Nancy Joan Patano
- Jashubhai N Patel
- Jitendrakumar Patel
- Nadzieja Nicole Pocheki
- Pokagon Band of Potawatomi Indians
- Pokagon Band of Potawatomi Indians
- Bertha Naomi Prahoveanu
- Prevos Family Markets LLC
- Ram Drugs LLC
- Mohammed Amjad Ranginwala
All providers in Dowagiac, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.