NPIMap

Organization Active NPI

Bad River Band of Lake Superior Tribe of Chippewa Indians Wis

  • Federally Qualified Health Center (FQHC)
  • Ashland, WI
National Provider Identifier
1699701375
Registry record updated Apr 6, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS
Practice address
53585 Nokomis Road
Ashland, WI 54806-4272
Phone
(715) 682-7133
Fax
(715) 685-7857
NPI assigned
Jun 24, 2006
Last updated
Apr 6, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 6, 2016

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

Authorized official

Name
Mrs. Debra Ann Tutor
Title
Clinic Administrator
Phone
(715) 682-7133

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X WI
Public Health or Welfare Agency 251K00000X WI
Clinic/Center 261Q00000X WI
Federally Qualified Health Center (FQHC) 261QF0400X WI Primary

Addresses

Primary practice location

53585 Nokomis Road
Ashland, WI 54806-4272

Mailing address

53585 Nokomis Road
Ashland, WI 54806-4272
Phone (715) 682-7133

Other names 1

  • Bad River Health and Wellness Center Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, WI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20080808000523 TX Part B Supplier - Pharmacy 7810089414 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ashland, WI
O20090825000440 WI Part A Provider - Indian Health Services Facility 7810089414 Practice locations: Odanah, WI
O20160330000840 TX Part B Supplier - Clinic/Group Practice 7810089414 Receives reassigned benefits from 31 practitioners
1 other NPI on this enrollment
Practice locations: Ashland, WI

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Bad River CL-Pharmacy

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459900800000",
    "number": "1699701375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53585 NOKOMIS ROAD",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548064272",
            "telephone_number": "715-682-7133",
            "fax_number": "715-685-7857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "53585 NOKOMIS ROAD",
            "city": "ASHLAND",
            "state": "WI",
            "postal_code": "548064272",
            "telephone_number": "715-682-7133",
            "fax_number": "715-685-7857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2006-06-24",
        "last_updated": "2016-04-06",
        "status": "A",
        "authorized_official_last_name": "TUTOR",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "715-682-7133",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bad River Health and Wellness Center",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Ashland, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2016; 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.