NPIMap

Organization Active NPI

Oneida Nation

  • Clinic/Center
  • Oneida, WI
National Provider Identifier
1740278308
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
ONEIDA NATION
Practice address
525 Airport Dr
Oneida, WI 54155-9035
Phone
(920) 869-2711
NPI assigned
Oct 7, 2005
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Debra Danforth, RN,BSN
Title
Comprehensive Health Operations Man
Phone
(920) 869-4807

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X WI Primary

Addresses

Primary practice location

525 Airport Dr
Oneida, WI 54155-9035

Mailing address

PO Box 365
Oneida, WI 54155-0365
Phone (920) 869-2711

Other identifiers 1

IdentifierTypeStateIssuer
32956500MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031224000077 WI Part B Supplier - Clinic/Group Practice 6800794074 Receives reassigned benefits from 81 practitioners
1 other NPI on this enrollment
Practice locations: Green Bay, WI; Oneida, WI

Other NPIs with the same Medicare PAC ID 1

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

  • Oneida Nation

    dba Anna John Resident Centered Care Community

    • Skilled Nursing Facility
    • Oneida, WI
    • NPI 1407916174

    6800794074

    Same PAC ID

Other NPIs on the same Medicare enrollment 1

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

  • Oneida Nation

    dba Ka Ni Kuhli Yo Family Center

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Green Bay, WI
    • NPI 1205825130

    O20031224000077

    Same enrollment

National Provider Directory

National Provider Directory

Locations

N5715 County Rd E
De Pere, WI 54115
Phone (920) 869-2711

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anna John Resident Care Centered CommunityOneida, WI, CCN 525695 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 1, 1975

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Oneida Nation

    dba Anna John Resident Centered Care Community

    • Skilled Nursing Facility
    • Oneida, WI
    • NPI 1407916174

    5% Or Greater Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 95

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 95

NPI Registry JSON

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

{
    "created_epoch": "1128643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1740278308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541550365",
            "telephone_number": "920-869-2711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 AIRPORT DR",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541559035",
            "telephone_number": "920-869-2711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONEIDA NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-07",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "DANFORTH",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "COMPREHENSIVE HEALTH OPERATIONS MAN",
        "authorized_official_telephone_number": "920-869-4807",
        "authorized_official_credential": "RN,BSN"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32956500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oneida, WI

Sources for this page

Verify at the official NPI Registry.