Lake Superior Community Health Center

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

LAKE SUPERIOR COMMUNITY HEALTH CENTER

Practice address

3600 Tower Avenue
Superior, WI 54880-5337

Phone

(715) 392-1955

Fax

(715) 392-1935

NPI assigned

Apr 23, 2007

Last updated

Feb 8, 2021By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jessie Peterson

Title

Coo

Phone

(218) 722-1497

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lake Superior Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Superior, WI
  • NPI 1063789022

  O20110205000134

  Same enrollment

Locations

Practitioners 6

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.

• Emily J Anderson, MD

  • Family Medicine Physician
  • Superior, WI
  • NPI 1770551335
  NPD
• Jason C. Bramstedt, DC

  • Chiropractor
  • Superior, WI
  • NPI 1487647723
  NPD
• Zoe Kunze, PA-C

  • Physician Assistant
  • Superior, WI
  • NPI 1780383182
  NPD
• Brittany Morgan Hamm, APRN, CNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Duluth, MN
  • NPI 1417598079
  NPD
• Kraig Robert Peterson, LGSW

  • Clinical Social Worker
  • Duluth, MN
  • NPI 1093293326
  NPD
• Shayla Jo Tschakert, PA

  • Physician Assistant
  • Omaha, NE
  • NPI 1902526122
  NPD

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612742400000",
    "number": "1578781639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 N 34TH ST STE 200",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548804477",
            "telephone_number": "715-395-5380",
            "fax_number": "715-394-2682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 TOWER AVENUE",
            "city": "SUPERIOR",
            "state": "WI",
            "postal_code": "548805337",
            "telephone_number": "715-392-1955",
            "fax_number": "715-392-1935"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3626 Hammond Ave",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548804483",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1201 N 28th St",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548805131",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "129 N 28th St E",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548806548",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1807 Missouri Ave",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548802225",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10465 E US Highway 2",
            "address_purpose": "LOCATION",
            "city": "Poplar",
            "state": "WI",
            "postal_code": "548649203",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4465 E Cty Rd B",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548808416",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4751 S Cty Rd F",
            "address_purpose": "LOCATION",
            "city": "Maple",
            "state": "WI",
            "postal_code": "548549159",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2600 Catlin Ave",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548805133",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6200 E 3rd St",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548804390",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1423 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548805963",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1500 N 34th St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Superior",
            "state": "WI",
            "postal_code": "548804477",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "8993 E Baldwin Ave",
            "address_purpose": "LOCATION",
            "city": "Solon Springs",
            "state": "WI",
            "postal_code": "548738144",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "10523 E US Hwy 2",
            "address_purpose": "LOCATION",
            "city": "Poplar",
            "state": "WI",
            "postal_code": "548649203",
            "country_code": "US",
            "telephone_number": "715-395-5380",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LAKE SUPERIOR COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2021-02-08",
        "certification_date": "2021-02-08",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "JESSIE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "218-722-1497"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32957500",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "654448700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Oscar Laberge, PHARMD
• Amy Marie Laflamme, P.A.
• Kimberly Ann Laible, C.O.T.A.
• Lake Superior Chiropractic Office, S.C.
• Lake Superior Community Health Center
• Lake Superior Community Health Center
• James Sebastian Lane
• Ryan Michael Sahand Lane, MSW, LGSW
• Lange Chiropractic Centers, S.C. (Lange-Laughlin Chiropractic Center)
• Michael Lao

• Federally Qualified Health Center (FQHC) in Superior, WI
• Providers in Superior, WI by specialty
• Federally Qualified Health Center (FQHC) in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.