Sault Tribe of Chippewa Indians
Organization Active NPI Optometrist · Sault Sainte Marie, MI
NPI 1902074586 · NPPES record last updated May 30, 2008
Key facts
- NPI
- 1902074586
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- SAULT TRIBE OF CHIPPEWA INDIANS
- Practice address
- 2864 Ashmun St
Sault Sainte Marie, MI 49783-3740 - Phone
- (906) 632-5200
- Fax
- (906) 632-5276
- NPI assigned
- Feb 15, 2008
- Organization subpart
- No
Authorized official
- Name
- Bonnie L Culfa
- Title
- Division of Health Director
- Phone
- (906) 632-5200
Owned or controlled facilities with NPI records 7
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 15
Practitioners 45
-
Krysta Danyell Hinman, O.D.
-
Benjamin Lawless, OD
-
Dale W Muth, O.D.
-
Dale Johnson, O.D.
-
Carla A Behling, CFNP
-
Rae Ann Brand, CFNP
-
Myrth Crystal Condon, N.P.
-
Mallinda Lumsden, LMSW
-
Zara Masood, M.D.
-
Denise J Neubauer, DNP
-
Teresa Ann Plummer, FNP-C
-
Tina M Pountney, FNP-BC
-
Andrew Josiah Rife, P.A.
-
Lowell Lamar Styer, M.D.
-
Rebeckah Zaragoza, LMSW
-
Margaret Comfort, PA
-
Eileen S Gavin, M.D.
-
Christine M Hamilton, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
All facility ownership & control disclosures 6
| Facility | Type | Role | Since |
|---|---|---|---|
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1994 |
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1994 |
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Jun 25, 2007 |
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Sep 5, 2007 |
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest | Sep 5, 2007 |
| Sault Tribe of Chippewa Indians |
Federally qualified health center | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 1994 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051021000891 | MI | Part B Supplier - Clinic/Group Practice | 7012982937 |
Receives reassigned benefits from 4 practitioners Practice locations: Sault Sainte Marie, MI |
National Provider Directory
- Tax ID family
- Sault Ste Marie Tribe O
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Federally Qualified Health Center (FQHC) | 261QF0400X |
Addresses
Primary practice location
2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Mailing address
2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Phone (906) 632-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0A76010 | Other | MI | BC/BS OF MI |
Other providers in Sault Sainte Marie, MI
- Sault Tribe of Chippewa Indians
- Sault Tribe of Chippewa Indians
- Sault Tribe of Chippewa Indians
- Sault Tribe of Chippewa Indians
- Sault Tribe of Chippewa Indians
- Sault Tribe of Chippewa Indians
- Sault Vision Clinic, P.C.
- Sault Womens Health
- Lilly Sauve
- Kristen Nicole Sawruk
All providers in Sault Sainte Marie, MI · Optometrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 30, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.