NPIMap

Organization Active NPI

Bad River Band of Lake Superior Tribe of Chippewa Indians Wis.

Doing business as Bad River Clinic Pharmacy

  • Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
  • Ashland, WI
National Provider Identifier
1780702829
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyTaxonomy code 332800000X
Legal business name
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS.
Doing business as
Bad River Clinic Pharmacy
Practice address
53585 Nokomis Road
Ashland, WI 54806-4272
Phone
(715) 682-7133
Fax
(715) 685-8810
NPI assigned
Mar 27, 2007
Last updated
Jun 3, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
BAD RIVER BAND OF LAKE SUPERIOR TRIBE OF CHIPPEWA INDIANS WIS.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

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

Authorized official

Name
June Louise Williams
Title
Billing/PRC Manager
Phone
(715) 682-7133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy 332800000X Primary

Addresses

Primary practice location

53585 Nokomis Road
Ashland, WI 54806-4272

Mailing address

53585 Nokomis Road
Ashland, WI 54806-4272
Phone (715) 682-8518

Other identifiers 1

IdentifierTypeStateIssuer
32787800MedicaidWI

Other names 1

  • Bad River Clinic Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080808000523 TX Part B Supplier - Pharmacy 7810089414 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 1

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 42

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 42

NPI Registry JSON

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

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717372800000",
    "number": "1780702829",
    "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": "715-682-8518",
            "fax_number": "715-682-7753"
        },
        {
            "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": "715-685-8810"
        }
    ],
    "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 WIS.",
        "enumeration_date": "2007-03-27",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "JUNE",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "BILLING/PRC MANAGER",
        "authorized_official_telephone_number": "715-682-7133"
    },
    "taxonomies": [
        {
            "code": "332800000X",
            "taxonomy_group": "",
            "desc": "Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32787800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bad River Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bad River Clinic Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jun 3, 2024; 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.