NPIMap

Organization Active NPI

Sault Tribe of Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Manistique, MI
National Provider Identifier
1588717839
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
231842 Issued in MI
Legal business name
SAULT TRIBE OF CHIPPEWA INDIANS
Practice address
5698W Hwy Us2
Manistique, MI 49854
Phone
(906) 341-8442
Fax
(906) 341-8470
NPI assigned
Jan 19, 2007
Organization subpart
Yes
Parent organization
SAULT TRIBE OF CHIPPEWA INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 16, 2024

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

Authorized official

Name
Joel Lumsden
Title
Assistant Health Director
Phone
(906) 632-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 231842 MI Primary

Addresses

Primary practice location

5698W Hwy Us2
Manistique, MI 49854

Mailing address

5698W Hwy Us2
Manistique, MI 49854
Phone (906) 341-8442

Other identifiers 1

IdentifierTypeStateIssuer
231842OtherMIFQHC FACILITY NUMBER

Other names 1

  • Manistique Tribal Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040901001322 MI Part B Supplier - Clinic/Group Practice 7012982937 Receives reassigned benefits from 17 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sault S Marie, MI
O20070425000014 MI Part A Provider - Federally Qualified Health Center (FQHC) 7012982937 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manistique, MI

Federally qualified health center certification: CCN 231842

Legal name
SAULT TRIBE OF CHIPPEWA INDIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
5698W Hwy Us2
Manistique, MI 49854

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Sault Ste Marie Tribe O

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joel Lumsden Individual Corporate DirectorAssistant Health Director Jan 1, 2018
Jacquelyn S McLean Individual W-2 Managing EmployeeHealth Care Administrator Jul 26, 2013
Sault Tribe of Chippewa Indians Organization, Sault Saint Marie, MI 5% Or Greater Direct Ownership Interest Jan 1, 1994 100%

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1588717839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5698W HWY US2",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "49854",
            "telephone_number": "906-341-8442",
            "fax_number": "906-341-8470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5698W HWY US2",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "49854",
            "telephone_number": "906-341-8442",
            "fax_number": "906-341-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2007-01-19",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "status": "A",
        "authorized_official_last_name": "LUMSDEN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "ASSISTANT HEALTH DIRECTOR",
        "authorized_official_telephone_number": "906-632-5200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": "231842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC FACILITY NUMBER",
            "identifier": "231842",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Manistique Tribal Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manistique, MI

Sources for this page

Verify at the official NPI Registry.