NPIMap

Organization Active NPI

White Earth Band of Chippewa

  • Home Health Agency
  • White Earth, MN
National Provider Identifier
1649295502
Registry record updated Jul 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
330865 Issued in MN
Legal business name
WHITE EARTH BAND OF CHIPPEWA
Practice address
26246 Crane Rd
White Earth, MN 56591-9998
Phone
(218) 983-3285
Fax
(218) 983-3742
NPI assigned
Jul 13, 2006
Last updated
Jul 28, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2010

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

Authorized official

Name
Patricia A Butler, RN, BSN, PHN
Title
PHN-Manager
Phone
(218) 983-3285

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 330865 MN Primary

Addresses

Primary practice location

26246 Crane Rd
White Earth, MN 56591-9998

Mailing address

PO Box 496
26246 Crane Rd
White Earth, MN 56591-0496
Phone (218) 983-3285

Other identifiers 4

IdentifierTypeStateIssuer
151255201MedicaidMN
5900118OtherMNMEDICA
151255200,727667200MedicaidMN
8297WHOtherMNBCBS OF MN

Other names 1

  • White Earth Home Health Agency Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20060829000286 MN Part A Provider - Home Health Agency 7315993995 Practice locations: White Earth, MN
O20190515000505 MN Part B Supplier - Mass Immunization (Roster Biller Only) 7315993995 Practice locations: White Earth, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649295502. Details of each certification follow.

Home health agency certification: CCN 247096

Legal name
WHITE EARTH BAND OF CHIPPEWA
Doing business as
WHITE EARTH HOME HEALTH AGENCY
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 14, 1980
Last certification
Feb 14, 2020
Ownership / control type
Government Operated
Organization structure
GovernmentNon-profit
Enrollment address
26246 Crane Rd
White Earth, MN 56591-9998

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
White Earth Home HealthCCN 247096 · All quality measures
Ownership
Government Operated
Certified
Jan 14, 1980
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

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
24D0983980White Earth Home Health Agency26246 Crane Road, White Earth, MN 56591Certificate of waiverMar 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
White Earth Band of Chippewa Indians26 organizations share this tax ID, including this one

Other organizations with this tax ID 25

Organizations that report the same tax identification number in the National Provider Directory.

View all 25

Locations

35500 Eagle View Rd
Ogema, MN 56569

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
Micheal Fairbanks Individual Corporate OfficerTribal Chairperson Jun 18, 2019 1%
Lindsi Darco Individual Corporate DirectorTribal Health Director Dec 2, 2023
Operational/Managerial ControlTribal Health Director Dec 2, 2023
White Earth Band of Chippewa Organization, Ogema, MN 5% Or Greater Direct Ownership Interest Dec 1, 2010 100%

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280275200000",
    "number": "1649295502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 496",
            "address_2": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565910496",
            "telephone_number": "218-983-3285",
            "fax_number": "218-983-3724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26246 CRANE RD",
            "city": "WHITE EARTH",
            "state": "MN",
            "postal_code": "565919998",
            "telephone_number": "218-983-3285",
            "fax_number": "218-983-3742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE EARTH BAND OF CHIPPEWA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2010-07-28",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PHN-MANAGER",
        "authorized_official_telephone_number": "218-983-3285",
        "authorized_official_credential": "RN, BSN, PHN"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "330865",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151255201",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5900118",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151255200,727667200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MN",
            "identifier": "8297WH",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "White Earth Home Health Agency",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in White Earth, MN

Sources for this page

Verify at the official NPI Registry.