NPIMap

Organization Active NPI

Sault Tribe of Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Munising, MI
National Provider Identifier
1780737403
Registry record updated Oct 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
License
231843 Issued in MI
Legal business name
SAULT TRIBE OF CHIPPEWA INDIANS
Practice address
622 W Superior St
Munising, MI 49862-1329
Phone
(906) 387-4614
Fax
(906) 387-4727
NPI assigned
Jan 18, 2007
Last updated
Oct 18, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SAULT TRIBE OF CHIPPEWA INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 18, 2024

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

Authorized official

Name
Joel Lumsden
Title
Assistant Health Director
Phone
(906) 632-5200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X 231843 MI Primary

Addresses

Primary practice location

622 W Superior St
Munising, MI 49862-1329

Mailing address

622 W Superior St
Munising, MI 49862-1329
Phone (906) 387-4614

Other names 1

  • Munising Tribal Health Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040901001322 MI Part B Supplier - Clinic/Group Practice 7012982937 Receives reassigned benefits from 17 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sault S Marie, MI
O20070425000032 MI Part A Provider - Federally Qualified Health Center (FQHC) 7012982937 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Munising, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780737403. Details of each certification follow.

Federally qualified health center certification: CCN 231843

Legal name
SAULT TRIBE OF CHIPPEWA INDIANS
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 1991
Last certification
Oct 1, 1991
Ownership / control type
For profit – corporation
Organization structure
OtherProprietary
Enrollment address
622 W Superior St
Munising, MI 49862-1329

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Sault Tribe of Indians

Locations

622 W Superior St
Munising, MI 49862
Phone (906) 387-4614

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Joel Lumsden Individual Corporate DirectorAssistant Health Director Oct 1, 2016 10%
Jacquelyn S McLean Individual W-2 Managing EmployeeHealth Care Administrator Oct 1, 1993 10%
Sault Tribe of Chippewa Indians Organization, Sault Sainte Marie, MI 5% Or Greater Direct Ownership Interest Jun 25, 2007

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729209600000",
    "number": "1780737403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "622 W SUPERIOR ST",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621329",
            "telephone_number": "906-387-4614",
            "fax_number": "906-387-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "622 W SUPERIOR ST",
            "city": "MUNISING",
            "state": "MI",
            "postal_code": "498621329",
            "telephone_number": "906-387-4614",
            "fax_number": "906-387-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2007-01-18",
        "last_updated": "2024-10-18",
        "certification_date": "2024-10-18",
        "status": "A",
        "authorized_official_last_name": "LUMSDEN",
        "authorized_official_first_name": "JOEL",
        "authorized_official_title_or_position": "ASSISTANT HEALTH DIRECTOR",
        "authorized_official_telephone_number": "906-632-5200"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": "231843",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munising Tribal Health Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Munising, MI

Sources for this page

Verify at the official NPI Registry.