PHS INDIAN HOSPITAL — NPI 1609392992 (Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) in REDLAKE, MN)

CMS-1500 Box 24J / 33a • NPI

1609392992

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

1223G0001X (CMS C5)

Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)

Box 32 Service Location & ZIP+4

PO BOX 497, REDLAKE, MN, 56671-0497

✓ 9-Digit EDI 837 ZIP+4 (56671-0497)

Practice Phone & Referral Fax

(218) 679-3912

Fax: (218) 679-0181

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1609392992 (PHS INDIAN HOSPITAL) 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	`1609392992` (NPI-2 Organization / Facility)
Provider / Legal Name	PHS INDIAN HOSPITAL
Plain-English Specialty	Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD) NUCC Code: `1223G0001X` (Dentist, General Practice)
Certifying / Licensing Body	American Dental Association (ADA) / State Board of Dental Examiners
Practice Location Address	PO BOX 497, REDLAKE, MN, 56671-0497
Practice Telephone / Fax	Tel: (218) 679-3912 \| Fax: (218) 679-0181
Administrative Mailing Address	24760 HOSPITAL DRIVE, RED LAKE, MN, 56671
Enumeration & Last Sync	Enumerated: 2017-08-17 \| CMS Record Updated: 2022-07-21
Authorized Official	JANICE THUNDER (BUSINESS OFFICE MANAGER)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

PO BOX 497, REDLAKE, MN, 56671-0497

🗺️ Open in Google Maps 🏥 More Providers in REDLAKE

🔒 Are you PHS INDIAN HOSPITAL? Get your Verified NPI Clinic Badge or request personal phone/address redaction →

Plain-English Taxonomy & CMS Crosswalk (1223G0001X)

What Does Taxonomy Code 1223G0001X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 1223G0001X translates to:
"Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code C5 (Dentist)
Certifying / Accrediting Authority: American Dental Association (ADA) / State Board of Dental Examiners
Clinical Scope: Routine 6-month dental checkups, toothache, dental abscess, bleeding gums (periodontitis), or wisdom tooth extraction.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (PHS INDIAN HOSPITAL)

Typical CPT / Diagnostic Procedures:

Comprehensive Oral Evaluation, Digital Dental Radiographs & Prophylaxis
Restorative Composite Fillings, Crowns, Endodontic Root Canal & Extractions

Common Therapeutic Classes:

Amoxicillin, Metronidazole & Clindamycin (Odontogenic Infections)
Chlorhexidine Gluconate 0.12% Oral Rinse & High-Fluoride Varnish

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`1223G0001X` — Dentist, General Practice Plain English: Licensed Doctor of Dental Surgery (DDS) / Doctor of Medicine in Dentistry (DMD)	State: MN \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.

Launch Bulk NPI Checker → JSON API Docs

PHS INDIAN HOSPITAL (NPI #1609392992)