Lynn Marie Squanda, DO
Individual provider Active NPI Family Medicine Physician · Saint Ignace, MI
NPI 1962437400 · NPPES record last updated Dec 31, 2024
Key facts
- NPI
- 1962437400
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 5101013512 (MI)
- Practice address
- 1140 N State St
Saint Ignace, MI 49781-1048 - Phone
- (906) 643-8689
- Fax
- (906) 643-4165
- NPI assigned
- Jul 12, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Michigan State University College of Osteopathic Medicine, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Sault Tribe of Chippewa Indians
Practice addresses (Care Compare)
2864 Ashmun St
Sault S Marie, MI 49783-3740
Phone (906) 632-5200
Hospital & facility affiliations
- Mackinac Straits Hospital and Health Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20031209001079 | MI | Practitioner - Family Practice | 0840196903 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sault Tribe of Chippewa Indians | Family Medicine | Current |
Accepting new patients |
| Sault Tribe of Chippewa Indians | Current |
Accepting new patients | |
| Sault Tribe of Chippewa Indians | Current | Accepting new patients | |
| Sault Tribe of Chippewa Indians | Current | Accepting new patients | |
| Sault Tribe of Chippewa Indians | Current | Accepting new patients | |
| F&S Radiology, P.C. | Past |
Accepting new patients |
Locations
1140 N State St
Saint Ignace, MI 49781
Phone (906) 643-0466
2864 Ashmun St
Sault South Marie, MI 49783
Phone (906) 632-5200
Interoperability endpoints
- ms_lsquanda@landmarkhealth-direct.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101013512 | MI | Yes |
Addresses
Primary practice location
1140 N State St
Saint Ignace, MI 49781-1048
Mailing address
524 S Court Ave
Gaylord, MI 49735-1215
Phone (989) 350-4105
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4547432 | Medicaid | MI | |
| 0156910035 | Other | MI | BCBSM PROVIDER NUMBER |
| 381303843 | Other | TAX ID | |
| CC4805 | Other | MEDICARE RR PROV ID | |
| 11289516 | Other | CAQH PROVIDER ID |
Other names
- Lynn Marie Squanda
Other providers in Saint Ignace, MI
- Edward F Smith
- Joan Marie Smith
- Stephanie June Soblaskey
- Carol Jean Sodman-Morris
- Christey Eileen Solomon
- Audrey Elita Stenson
- Megan Lee Stenson
- John Stephenson
- Charlene Stier
- Straits Area Pharamcy Inc
All providers in Saint Ignace, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2024. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.