NPIMap

Organization Active NPI

Spirit Lake Tribe

  • Case Management Agency
  • Fort Totten, ND
National Provider Identifier
1720152457
Registry record updated Oct 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
SPIRIT LAKE TRIBE
Practice address
416 2ND Avenue North
Fort Totten, ND 58335
Phone
(701) 766-1238
Fax
(701) 766-1260
NPI assigned
Nov 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2019

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

Authorized official

Name
Peggy L. Cavanaugh
Title
Tribal Chairperson
Phone
(701) 381-2006

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Case Management Agency 251B00000X Primary

Addresses

Primary practice location

416 2ND Avenue North
Fort Totten, ND 58335

Mailing address

416 2ND Avenue North
PO Box 489
Fort Totten, ND 58335
Phone (701) 766-1238

Other identifiers 1

IdentifierTypeStateIssuer
1325MedicaidND

Other names 1

  • Early Childhood Tracking Doing business as

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
35D2149734Spirit Lake Early Childhood Tracking416 2ND Ave N, Fort Totten, ND 58335Certificate of waiverJun 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Spirit Lake Okiciyapi22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1570579200000",
    "number": "1720152457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 2ND AVENUE NORTH",
            "address_2": "PO BOX 489",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "58335",
            "telephone_number": "701-766-1238",
            "fax_number": "701-766-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 2ND AVENUE NORTH",
            "city": "FORT TOTTEN",
            "state": "ND",
            "postal_code": "58335",
            "telephone_number": "701-766-1238",
            "fax_number": "701-766-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPIRIT LAKE TRIBE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-17",
        "last_updated": "2019-10-09",
        "status": "A",
        "authorized_official_last_name": "CAVANAUGH",
        "authorized_official_first_name": "PEGGY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "TRIBAL CHAIRPERSON",
        "authorized_official_telephone_number": "701-381-2006"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1325",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Early Childhood Tracking",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Totten, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.