NPIMap

Organization Active NPI

Mille Lacs Band of Ojibwe Indians

  • Federally Qualified Health Center (FQHC)
  • McGregor, MN
National Provider Identifier
1962698571
Registry record updated Jun 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MILLE LACS BAND OF OJIBWE INDIANS
Practice address
36666 State Highway 65
McGregor, MN 55760
Phone
(218) 768-3311
Fax
(218) 768-6124
NPI assigned
Sep 18, 2007
Organization subpart
Yes
Parent organization
MILLE LACS BAND OF OJIBWE INDIANSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 4, 2024

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

Authorized official

Name
Nicole Anderson
Title
Commissioner Health & Human SVCS
Phone
(320) 532-4163

Specialties & licenses 1

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

Addresses

Primary practice location

36666 State Highway 65
McGregor, MN 55760

Mailing address

18562 Minobimaadizi Loop
Onamia, MN 56359
Phone (320) 532-4163

Other practice location 1

20849 370th Ln
McGregor, MN 55760-2201
Phone (218) 768-7090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090128000166 MN Part A Provider - Federally Qualified Health Center (FQHC) 5991869471 Practice locations: McGregor, MN

Federally qualified health center certification: CCN 241858

Legal name
MILLE LACS BAND OF OJIBWE INDIANS
Doing business as
EAST LAKE CLINIC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 5, 2009
Last certification
Mar 5, 2009
Ownership / control type
For profit – corporation
Organization structure
GovernmentNon-profit
Enrollment address
36666 State Highway 65
East Lake Clinic
McGregor, MN 55760-5710

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Mille Lacs Band of Ojibwe Indians16 organizations share this tax ID, including this one
Part of
Mille Lacs Band of Ojibwe Indians

Other organizations with this tax ID 15

Organizations that report the same tax identification number in the National Provider Directory.

View all 15

Locations

36666 State Highway 65
Ste 100
McGregor, MN 55760

18562 Minobimaadizi Loop
Onamia, MN 56359
Phone (320) 532-4163

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Mille Lacs Band of Ojibwe Indians Organization, McGregor, MN 5% Or Greater Direct Ownership Interest Jun 1, 1995 100%
Nicole Anderson Individual Corporate OfficerCommissioner of HHS Feb 14, 2019
W-2 Managing EmployeeCommissioner of HHS Feb 14, 2019
Operational/Managerial ControlCommissioner of HHS Feb 14, 2019
OtherCommisioner of HHS Feb 14, 2019

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Aazhoomog ( Lake Lena) ClinicSandstone, MN, CCN 241859 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 May 21, 2013
Jan 16, 2009
NE Ia Shing ClinicOnamia, MN, CCN 241819 Federally qualified health center Operational/Managerial Control Jun 30, 1978

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1190073600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717459200000",
    "number": "1962698571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18562 MINOBIMAADIZI LOOP",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "56359",
            "telephone_number": "320-532-4163",
            "fax_number": "320-532-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "36666 STATE HIGHWAY 65",
            "city": "MCGREGOR",
            "state": "MN",
            "postal_code": "55760",
            "telephone_number": "218-768-3311",
            "fax_number": "218-768-6124"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20849 370th Ln",
            "address_purpose": "LOCATION",
            "city": "McGregor",
            "state": "MN",
            "postal_code": "557602201",
            "country_code": "US",
            "telephone_number": "218-768-7090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MILLE LACS BAND OF OJIBWE INDIANS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS BAND OF OJIBWE INDIANS",
        "enumeration_date": "2007-09-18",
        "last_updated": "2024-06-04",
        "certification_date": "2024-05-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "COMMISSIONER  HEALTH & HUMAN SVCS",
        "authorized_official_telephone_number": "320-532-4163"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McGregor, MN

Sources for this page

Verify at the official NPI Registry.