LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS
NPI 1124052816
Clinic/Center - Federally Qualified Health Center (FQHC) in Petoskey, MI
About Little Traverse Bay Bands Of Odawa Indians NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LITTLE TRAVERSE BAY BANDS OF ODAWA INDIANS (NPI 1124052816) is a healthcare organization registered as a federally qualified health center (fqhc) in Petoskey, Michigan and active in the NPI registry since July 2006. The organization lists Christina Dubois, Assistant Health Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Little Traverse Bay Bands Of Odawa Indians is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by October 31, 2026
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
13Medicare enrollment records show 13 clinicians reassign Medicare billing to Little Traverse Bay Bands Of Odawa Indians, which bills Medicare for the services they deliver. Of these, 3 practice at this address and 9 within 10 miles. They are listed nearest first.
Clinicians by Medicare Specialty 6
Clinicians, nearest first (13)
Harbor Springs, MI 49740
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Little Traverse Bay Bands Of Odawa Indians's NPI number?
The NPI number for Little Traverse Bay Bands Of Odawa Indians is 1124052816. It was assigned to this organization in the NPPES registry on July 10, 2006.
Where is Little Traverse Bay Bands Of Odawa Indians located?
Little Traverse Bay Bands Of Odawa Indians is located at 1260 Ajijaak Ave, Petoskey, MI 49770. The listed phone number is (231) 242-1700.
What is Little Traverse Bay Bands Of Odawa Indians's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.
Is Little Traverse Bay Bands Of Odawa Indians enrolled in Medicare?
Yes. Little Traverse Bay Bands Of Odawa Indians is registered in the Medicare PECOS enrollment system.
When is Little Traverse Bay Bands Of Odawa Indians's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Part A enrollment for this organization (Michigan, Federally Qualified Health Center (FQHC)) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Little Traverse Bay Bands Of Odawa Indians?
According to the CMS Revalidation Reassignment List (October 2026 release), 13 clinicians in 6 Medicare specialties reassign their Medicare billing to Little Traverse Bay Bands Of Odawa Indians. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Clinical Social Worker (5), Family Practice (2) and Mental Health Counselor (2). Of these, 3 practice at this address and 9 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Little Traverse Bay Bands Of Odawa Indians accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Little Traverse Bay Bands Of Odawa Indians as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Little Traverse Bay Bands Of Odawa Indians was last updated on July 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Little Traverse Bay Bands Of Odawa Indians · NPI 1124052816
Federally Qualified Health Center (FQHC) organization in Petoskey, Michigan. Organization record, active in the CMS NPPES registry since July 10, 2006.
## Identity
- **NPI:** 1124052816 (Entity type: Organization)
- **Enumerated:** July 10, 2006
- **Primary specialty:** Clinic/Center - Federally Qualified Health Center (FQHC) · taxonomy 261QF0400X
- **Organization subpart:** No
- **Authorized official:** Christina Dubois, ASSISTANT HEALTH DIRECTOR
## Practice location
- **Address:** 1260 AJIJAAK AVE, Petoskey, MI 49770-8330
- **Phone:** (231) 242-1700 · **Fax:** (231) 242-1717
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** October 31, 2026 (Part A, Michigan, Federally Qualified Health Center (FQHC)) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 13 clinicians in 6 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Clinical Social Worker (5), Family Practice (2), Mental Health Counselor (2); 3 practice at this address and 9 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** July 25, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1124052816) · Data from the CMS NPPES public registry.