NPIMap

Organization Active NPI

Sault Tribe of Chippewa Indians

Doing business as St. Ignace Tribal Health Center

  • Federally Qualified Health Center (FQHC)
  • Saint Ignace, MI
National Provider Identifier
1891847067
Registry record updated Sep 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SAULT TRIBE OF CHIPPEWA INDIANS
Doing business as
St. Ignace Tribal Health Center
Practice address
1140 N State St
Saint Ignace, MI 49781-1048
Phone
(906) 643-8689
Fax
(906) 643-6716
NPI assigned
Jan 17, 2007
Last updated
Sep 16, 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 Sep 16, 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 Primary

Addresses

Primary practice location

1140 N State St
Saint Ignace, MI 49781-1048

Mailing address

1140 N State St
Saint Ignace, MI 49781-1048
Phone (906) 643-8689

Other identifiers 2

IdentifierTypeStateIssuer
231841OtherFQHC FACILITY NUMBER
23D0674396OtherMICLIA

Other names 1

  • St. Ignace Tribal Health Center Doing business as

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
O20090403000598 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: Saint Ignace, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891847067. Details of each certification follow.

Federally qualified health center certification: CCN 231841

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
Most recent change of ownership
Jul 31, 2000 (1 total)
Organization structure
GovernmentProprietary
Enrollment address
1140N State St 2805
Saint Ignace, MI 49781-1048

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
Original Band of Sault

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
W-2 Managing EmployeeAssistant Medical Director Dec 19, 2017
Jacquelyn S McLean Individual W-2 Managing EmployeeHealth Care Administrator Apr 15, 2009
Sault Tribe of Chippewa Indians Organization, Sault Sainte Marie, MI 5% Or Greater Direct Ownership Interest Jan 1, 1994 100%

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": "1168992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726444800000",
    "number": "1891847067",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 N STATE ST",
            "city": "SAINT IGNACE",
            "state": "MI",
            "postal_code": "497811048",
            "telephone_number": "906-643-8689",
            "fax_number": "906-643-6716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 N STATE ST",
            "city": "SAINT IGNACE",
            "state": "MI",
            "postal_code": "497811048",
            "telephone_number": "906-643-8689",
            "fax_number": "906-643-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SAULT TRIBE OF CHIPPEWA INDIANS",
        "enumeration_date": "2007-01-17",
        "last_updated": "2024-09-16",
        "certification_date": "2024-09-16",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FQHC  FACILITY NUMBER",
            "identifier": "231841",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "23D0674396",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Ignace Tribal Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Ignace, MI

Sources for this page

Verify at the official NPI Registry.