Bad River Band of Lake Superior Tribe of Chippewa Indians Wis
Organization Active NPI Federally Qualified Health Center (FQHC) · Ashland, WI
NPI 1699701375 · NPPES record last updated Apr 6, 2016
Key facts
- NPI
- 1699701375
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 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
- Organization subpart
- Yes
- Parent organization (as reported)
- BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS
Authorized official
- Name
- Mrs. Debra Ann Tutor
- Title
- Clinic Administrator
- Phone
- (715) 682-7133
Other NPIs on the same Medicare enrollment 2
Other NPIs with the same Medicare PAC ID 1
Member of 1
Practitioners 49
-
Pamela M Hayward, NP
-
Matthew John Horning, M.D.
-
Kristie Johnson, MD
-
Tammie S Jonas-Marsland, FNP-C
-
David C Larsen, DPM
-
Ashley Levra, PMHNP-BC
-
Shannon S Meyer, DPM
-
Alexander Anton Provost, D.C.
-
Pamela Joy Webber, FNP
-
Alison Spaude-Filipczak, CAPSW
-
Arif Iqbal, O.D.
-
James Everett Dunn, M.D.
-
Eileen S Gavin, M.D.
-
Sharon Handy, M.D.
-
Michael Saul Lundin, M.D.
-
Avari Miller, DC
-
Carrie Kay Bowman, P-MHNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in TX, WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 |
National Provider Directory
- Part of
- Bad River Band of Lake Superior Tribe of Chippewa Indains Wis
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist |
122300000X | WI | ||
| Public Health or Welfare Agency | 251K00000X | WI | ||
| Clinic/Center | 261Q00000X | WI | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X | WI | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| TRZ020 | Other | WI | TRAILBLAZER/MEDICARE |
| 32957600 | Medicaid | WI |
Other names
- Bad River Health and Wellness Center
Other providers in Ashland, WI
- Terrence P Asplund
- Michael D Auvinen
- Avanti Home Health Services, LLC
- Bad River Band of Lake Superior Tribe of Chippewa Indains Wis
- Bad River Band of Lake Superior Tribe of Chippewa Indians
- Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.
- Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.
- Bad River Health and Wellness Center
- Bad River Honoring Our Children
- Krishna Raj Bagale
All providers in Ashland, WI · Federally Qualified Health Center (FQHC) in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2016. 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.