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PRAIRIE BAND POTAWATOMI HEALTH CENTER
NPI 1245266410
Clinic/Center - Federally Qualified Health Center (FQHC) in Mayetta, KS

Active since June 22, 2006CLIA 17D0668588 · Accreditation
11400 158TH RD, MAYETTA, KS 66509(785) 966-8200(785) 966-8393 Get Directions Write a Review

NPPES record last updated: July 21, 2022. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Jul 21, 2022, Jun 20, 2018, Jan 17, 2018 (3 updates tracked since 2018).

About Prairie Band Potawatomi Health Center NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PRAIRIE BAND POTAWATOMI HEALTH CENTER (NPI 1245266410) is a healthcare organization registered as a federally qualified health center (fqhc) in Mayetta, Kansas and active in the NPI registry since June 2006. The organization holds an CLIA Accreditation certificate valid through November 19, 2027 and lists Tiffany Lewis, Business Office Manager, as its authorized official.

NPPES Registry Identity

NPI1245266410
Entity TypeOrganization
Primary Taxonomy261QF0400X
Legal Business NamePRAIRIE BAND POTAWATOMI NATION
Location Address11400 158TH RDMayetta, KS 66509-0249
Mailing Address11400 158th RdMayetta, KS 66509-0249 · (785) 966-8200 · Fax (785) 966-8393
Phone(785) 966-8200
Fax(785) 966-8393
Organization SubpartNo
Authorized OfficialTiffany LewisBusiness Office Manager · (785) 966-8282
Enumeration DateJune 22, 2006
Last NPPES UpdateJuly 21, 20223 updates tracked since enumeration
NPPES CertifiedJune 1, 2022
✔ NPI 1245266410 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyClinic/Center · Federally Qualified Health Center (FQHC)Ambulatory Health Care Facilities
Taxonomy Code261QF0400X
Also ListedClinic/Center · Health ServiceTaxonomy 261QH0100X
11400 158TH RD, Mayetta, KS 66509
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Other Names 1

Doing Business AsPrairie Band Potawatomi Health Center

Other Identifiers 1

Medicaid200259300AKS

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Sunflower Health Plan, Ambetter Health, Ambetter Health of Delaware and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Prairie Band Potawatomi Health Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

8

Medicare enrollment records show 8 clinicians reassign Medicare billing to Prairie Band Potawatomi Health Center, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 6 within 10 miles. They are listed nearest first.

Clinicians, nearest first (8)

Jamie Jacobsen, D.O.
Emergency Medicine
NPI 1669447330
11400 158TH RD
Mayetta, KS 66509
(785) 966-8200
✔ PECOS✔ Accepts MedicareSame address
Nicholas Eilert, APRN
Nurse Practitioner
NPI 1538696570
11400 158TH RD
Mayetta, KS 66509
(785) 966-8200
✔ PECOS✔ Accepts Medicare0.1 mi
Abra Friess, APRN
Nurse Practitioner
NPI 1083095996
11400 158TH RD
Mayetta, KS 66509
(785) 966-8200
✔ PECOS✔ Accepts Medicare0.1 mi
Joshua Langi, LMSW
Clinical Social Worker
NPI 1982524831
11400 158TH RD
Mayetta, KS 66509
(785) 966-8364
✔ PECOS0.1 mi
Karan Russell, APRN
Nurse Practitioner
NPI 1932524261
11400 158TH RD
Mayetta, KS 66509
(785) 966-8200
✔ PECOS✔ Accepts Medicare0.1 mi
Thierry Tchiengue, MD
Family Practice
NPI 1669122404
11400 158TH RD.
Mayetta, KS 66509
(785) 966-8200
✔ PECOS✔ Accepts Medicare0.1 mi
Emily Caudle, APRN
Nurse Practitioner
NPI 1396091153
823 SW MULVANE ST
Topeka, KS 66606
(785) 354-9591
✔ PECOS✔ Accepts Medicare20 mi
Rochelle Vale, DO
Family Practice
NPI 1750552154
4019 SW 10TH AVE
Topeka, KS 66604
(785) 496-4436
✔ PECOS20 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 17D0668588

Prairie Band Potawatomi Family Health Center · Mayetta, KS
Active · expires Nov 19, 2027
CLIA Number17D0668588
Laboratory TypeCommunity Clinic
Certificate Effective DateNovember 20, 2025
Certificate Expiration DateNovember 19, 2027
Laboratory DirectorMrs. Jessi R. Deters
Laboratory Phone(785) 966-8200
Laboratory LocationPrairie Band Potawatomi Family Health Center11400 158 Road (po Box 249), Mayetta, KS 66509
CLIA data matches this NPI record on: Phone
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

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 Prairie Band Potawatomi Nation's NPI number?

The NPI number for Prairie Band Potawatomi Nation is 1245266410. It was assigned to this organization in the NPPES registry on June 22, 2006. The provider is doing business as Prairie Band Potawatomi Health Center.

Where is Prairie Band Potawatomi Nation located?

Prairie Band Potawatomi Nation is located at 11400 158th Rd, Mayetta, KS 66509. The listed phone number is (785) 966-8200.

What is Prairie Band Potawatomi Nation's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Federally Qualified Health Center (FQHC), with taxonomy code 261QF0400X.

Is Prairie Band Potawatomi Nation enrolled in Medicare?

Yes. Prairie Band Potawatomi Nation is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Prairie Band Potawatomi Nation?

According to the CMS Revalidation Reassignment List (October 2026 release), 8 clinicians in 4 Medicare specialties reassign their Medicare billing to Prairie Band Potawatomi Nation. 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 Nurse Practitioner (4), Family Practice (2) and Clinical Social Worker (1). Of these, 1 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Prairie Band Potawatomi Nation hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 17D0668588) is associated with this NPI, valid through November 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Prairie Band Potawatomi Nation accept?

Health plans from Ambetter Health, Ambetter Health of Delaware, Ambetter from Sunflower Health Plan, Ambetter of Oklahoma and Blue Cross and Blue Shield of Kansas, Inc. list Prairie Band Potawatomi Nation 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 Prairie Band Potawatomi Nation was last updated on July 21, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years 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.