FOREST COUNTY POTAWATOMI COMMUNITY — NPI 1285741306 (Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center in CRANDON, WI)

CMS-1500 Box 24J / 33a • NPI

1285741306

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

261QF0400X (CMS B4[14])

Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center

Box 32 Service Location & ZIP+4

8201 MISH KO SWEN DRIVE, CRANDON, WI, 54520-8631

✓ 9-Digit EDI 837 ZIP+4 (54520-8631)

Practice Phone & Referral Fax

(715) 478-4300

Fax: (715) 478-4300

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1285741306 (FOREST COUNTY POTAWATOMI COMMUNITY) 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

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1285741306` (NPI-2 Organization / Facility)
Provider / Legal Name	FOREST COUNTY POTAWATOMI COMMUNITY
Plain-English Specialty	Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center NUCC Code: `261QF0400X` (Clinic/Center, Federally Qualified Health Center (FQHC))
Certifying / Licensing Body	Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Practice Location Address	8201 MISH KO SWEN DRIVE, CRANDON, WI, 54520-8631
Practice Telephone / Fax	Tel: (715) 478-4300 \| Fax: (715) 478-4300
Administrative Mailing Address	PO BOX 396, CRANDON, WI, 54520-0396
Enumeration & Last Sync	Enumerated: 2006-08-24 \| CMS Record Updated: 2020-12-09
Authorized Official	NED DANIELS (Tribal Chairman)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

8201 MISH KO SWEN DRIVE, CRANDON, WI, 54520-8631

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Plain-English Taxonomy & CMS Crosswalk (261QF0400X)

What Does Taxonomy Code 261QF0400X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 261QF0400X translates to:
"Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center"

CMS-1500 Medicare Specialty Crosswalk: CMS Code B4[14] (Federally Qualified Health Center)
Certifying / Accrediting Authority: Accreditation Association for Ambulatory Health Care (AAAHC) / CMS
Clinical Scope: Same-day outpatient consultations, urgent walk-in medical care, vaccinations, and day-case diagnostic procedures.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (FOREST COUNTY POTAWATOMI COMMUNITY)

Typical CPT / Diagnostic Procedures:

Walk-In Urgent Care Evaluation, Point-of-Care Testing & X-Ray
Same-Day Ambulatory Endoscopy, Cataract & Minor Surgical Procedures

Common Therapeutic Classes:

Outpatient Oral Antimicrobials, Analgesics, Nebulizers & Vaccines

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`132700000X` — Dietary Manager Plain English: Licensed & Credentialed Dietary Manager	State: N/A \| License: `Verified` \| Primary: Secondary
`133N00000X` — Nutritionist Plain English: Licensed & Credentialed Nutritionist	State: N/A \| License: `Verified` \| Primary: Secondary
`208000000X` — Pediatrics Plain English: Board-Certified Pediatrician (Infant, Child & Adolescent Medicine)	State: N/A \| License: `Verified` \| Primary: Secondary
`261QC1500X` — Clinic/Center, Community Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QD0000X` — Clinic/Center, Dental Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QH0700X` — Clinic/Center, Hearing and Speech Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QP1100X` — Clinic/Center, Podiatric Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0200X` — Clinic/Center, Radiology Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`261QR0206X` — Clinic/Center, Radiology, Mammography Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary
`291U00000X` — Clinical Medical Laboratory Plain English: CLIA-Certified Diagnostic Medical & Pathology Laboratory	State: N/A \| License: `Verified` \| Primary: Secondary
`332800000X` — Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy Plain English: Licensed & Credentialed Suppliers — Indian Health Service — Tribal — Urban Indian Health (I — T — U) Pharmacy	State: N/A \| License: `Verified` \| Primary: Secondary
`332B00000X` — Durable Medical Equipment & Medical Supplies Plain English: Licensed & Credentialed Suppliers — Durable Medical Equipment & Medical Supplies	State: N/A \| License: `Verified` \| Primary: Secondary
`332H00000X` — Eyewear Supplier (Equipment, not the service) Plain English: Licensed & Credentialed Eyewear Supplier (Equipment, not the service)	State: N/A \| License: `Verified` \| Primary: Secondary
`332S00000X` — Hearing Aid Equipment Plain English: Licensed & Credentialed Hearing Aid Equipment	State: N/A \| License: `Verified` \| Primary: Secondary
`261QF0400X` — Clinic/Center, Federally Qualified Health Center (FQHC) Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: WI \| License: `Verified` \| Primary: Yes (Primary)

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FOREST COUNTY POTAWATOMI COMMUNITY (NPI #1285741306)