CMS-1500 Box 24J / 33a • NPI
1073530150
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
332800000X (CMS A9[12])
Licensed & Credentialed Suppliers — Indian Health Service — Tribal — Urban Indian Health (I — T — U) Pharmacy
Box 32 Service Location & ZIP+4
5219 ST. JOHN DR, NETT LAKE, MN, 55772
Official NPPES Practice Location
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1073530150 (BOIS FORTE RESERVATION TRIBAL GOVERNMENT) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1073530150 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | BOIS FORTE RESERVATION TRIBAL GOVERNMENT |
| Plain-English Specialty | Licensed & Credentialed Suppliers — Indian Health Service — Tribal — Urban Indian Health (I — T — U) Pharmacy NUCC Code: 332800000X (Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 5219 ST. JOHN DR, NETT LAKE, MN, 55772 |
| Practice Telephone / Fax | Tel: (218) 757-3650 |
| Administrative Mailing Address | 5219 SAINT JOHN DR, ORR, MN, 55771-8232 |
| Enumeration & Last Sync | Enumerated: 2006-07-16 | CMS Record Updated: 2026-11-10 |
| Authorized Official | CARLOS HERNANDEZ (Tribal Chairman) |
Clinic Location, Accessibility & Directions
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Plain-English Taxonomy & CMS Crosswalk (332800000X)
What Does Taxonomy Code 332800000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 332800000X translates to:
"Licensed & Credentialed Suppliers — Indian Health Service — Tribal — Urban Indian Health (I — T — U) Pharmacy"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (BOIS FORTE RESERVATION TRIBAL GOVERNMENT)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
207Q00000X — Family MedicinePlain English: Board-Certified Family Medicine Physician (All-Ages Primary Care Doctor) | State: N/A | License: Verified | Primary: Secondary |
251B00000X — Case ManagementPlain English: Licensed & Credentialed Case Management | State: N/A | License: Verified | Primary: Secondary |
332800000X — Indian Health Service/Tribal/Urban Indian Health (I/T/U) PharmacyPlain English: Licensed & Credentialed Suppliers — Indian Health Service — Tribal — Urban Indian Health (I — T — U) Pharmacy | State: N/A | License: Verified | Primary: Yes (Primary) |
332U00000X — Home Delivered MealsPlain English: Licensed & Credentialed Home Delivered Meals | State: N/A | License: Verified | Primary: Secondary |
385H00000X — Respite CarePlain English: Licensed & Credentialed Respite Care | State: N/A | License: Verified | Primary: Secondary |
Medical Billing, RCM & Hospital Credentialing Teams:
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