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FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
NPI 1376650499
Clinic/Center - Mental Health (Including Community Mental Health Center) in Crandon, WI

Active since August 24, 2006CLIA 52D0678081 · Accreditation
8201 MISH KO SWEN DR, CRANDON, WI 54520(715) 478-4300(715) 478-4490 Get Directions Write a Review

NPPES record last updated: December 9, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Forest County Potawatomi Health & Wellness Center NPPES

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

FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER (NPI 1376650499) is a healthcare organization registered as a mental health (including community mental health center) in Crandon, Wisconsin and active in the NPI registry since August 2006. The organization holds an CLIA Accreditation certificate valid through May 17, 2028 and lists Ned Daniels, Tribal Chairman, as its authorized official.

NPPES Registry Identity

NPI1376650499
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameFOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Location Address8201 MISH KO SWEN DRCrandon, WI 54520-8631
Mailing AddressPo Box 396, 8201 Mish Ko Swen DriveCrandon, WI 54520-0396 · (715) 478-4300 · Fax (715) 478-4490
Phone(715) 478-4300
Fax(715) 478-4490
Organization SubpartNo
Authorized OfficialNed DanielsTribal Chairman · (715) 478-4824
Enumeration DateAugust 24, 2006
Last NPPES UpdateDecember 9, 2020
NPPES CertifiedDecember 9, 2020
✔ NPI 1376650499 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
Also ListedCounselor · Addiction (Substance Use Disorder)Taxonomy 101YA0400X
Also ListedClinic/Center · Adult Mental HealthTaxonomy 261QM0850X
Also ListedClinic/Center · Adolescent and Children Mental HealthTaxonomy 261QM0855X
8201 MISH KO SWEN DR, Crandon, WI 54520
Open in Google Maps ↗

Other Identifiers 1

Medicaid42182600WI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Forest County Potawatomi Health & Wellness Center is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

31

Medicare enrollment records show 31 clinicians reassign Medicare billing to Forest County Potawatomi Health & Wellness Center, which bills Medicare for the services they deliver. Of these, 8 practice at this address and 13 within 10 miles. Listed here are the 20 practicing nearest to this location.

Clinicians by Medicare Specialty 13

Nurse Practitioner7
Clinical Social Worker4
Optometry4
Podiatry3
Chiropractic2
Mental Health Counselor2
Physical Therapist in Private Practice2
Psychiatry2
5 other specialties5

Nearest to this location (20)

See all 31
Amy Booher, APSW
Mental Health Counselor
NPI 1699436733
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4339
✔ PECOSSame address
Amanda Lallensack, OD
Optometry
NPI 1477178259
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ PECOS✔ Accepts MedicareSame address
Bonnie Samuelson, M.D.
Emergency Medicine
NPI 1962432658
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ PECOS✔ Accepts MedicareSame address
Angela Wales, DPT
Physical Therapist in Private Practice
NPI 1932691771
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4344
✔ Accepts MedicareSame address
Laura Donatelle, DNP APRN FNP
Nurse Practitioner
NPI 1326574732
FOREST COUNTY POTAWATOMI 8201 MISH KO SWEN DRIVE
Crandon, WI 54501
(715) 478-4300
✔ PECOS✔ Accepts MedicareSame address
Aubrey Leigh Newton, LPC
Mental Health Counselor
NPI 1497500391
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ PECOSSame address
Ashley Seiler, NP
Nurse Practitioner
NPI 1992015580
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4332
✔ PECOS✔ Accepts MedicareSame address
Jennifer Stein, FNP-C
Nurse Practitioner
NPI 1457632747
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ PECOS✔ Accepts MedicareSame address
Jodi Space, APNP
Nurse Practitioner
NPI 1518217280
5416 EVERYBODYS RD
Crandon, WI 54520
(715) 478-4890
✔ PECOS✔ Accepts Medicare0.1 mi
Andrew Kelly, PT
Physical Therapist in Private Practice
NPI 1508025347
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ Accepts Medicare0.2 mi
Jacklin Sailo, FNP
Nurse Practitioner
NPI 1053619387
8201 MISH KO SWEN DR
Crandon, WI 54520
(715) 478-4300
✔ PECOS✔ Accepts Medicare0.2 mi
Brandy Jastrow, LCSW
Clinical Social Worker
NPI 1124521414
PO BOX 396
Crandon, WI 54520
(715) 478-4339
✔ PECOS✔ Accepts Medicare4.6 mi
William Pierre, OD TPA
Optometry
NPI 1114935095
8201 MISHKOSEN DR FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Crandon, WI 54520
(715) 478-4300
✔ PECOS✔ Accepts Medicare4.6 mi
Esmeralda Rawat, MSW, LCSW
Clinical Social Worker
NPI 1861896540
1225 LANGLADE RD
Antigo, WI 54409
(715) 627-6694
✔ PECOS32 mi
Melissa Jensen, APNP-C
Nurse Practitioner
NPI 1295381481
112 E 5TH AVE
Antigo, WI 54409
(715) 623-9225
✔ PECOS✔ Accepts Medicare33 mi
Sylvia Dennison, MD
Psychiatry
NPI 1700838836
110 E 5TH AVE
Antigo, WI 54409
(715) 623-2351
✔ PECOS✔ Accepts Medicare33 mi
Audry Poquette, O.D.
Optometry
NPI 1568742229
200 FAIRBANKS ST STE 1
Iron Mountain, MI 49801
(906) 774-8280
✔ PECOS41 mi
Shannon Meyer, DPM
Podiatry
NPI 1316933542
311 ELM ST
Woodruff, WI 54568
(715) 634-9023
✔ PECOS✔ Accepts Medicare47 mi
Ann Novak
Pediatric Medicine
NPI 1356845762
9576 HWY 70
Minocqua, WI 54548
(715) 358-1709
✔ PECOS47 mi
Avari Miller, DC
Chiropractic
NPI 1588310148
W5675 COUNTY ROAD B
Shawano, WI 54166
(715) 526-6158
58 mi
See all 31 clinicians

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 52D0678081

Forest Cty Potawatomi Health And Wellness Center · Crandon, WI
Active · expires May 17, 2028
CLIA Number52D0678081
Laboratory TypeFederally Qualified Health Center
Certificate Effective DateMay 18, 2026
Certificate Expiration DateMay 17, 2028
Laboratory DirectorMs. Sher Mcgregor
Laboratory Phone(715) 478-4343
Laboratory LocationForest Cty Potawatomi Health And Wellness Center8201 Mish Ko Swen Drive, Crandon, WI 54520
CLIA data matches this NPI record on: Address
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.

Medical Equipment Supplier Medicare DMEPOS 7

Medicare supplier enrollment and the product categories Forest County Potawatomi Community carries, from the Medicare DMEPOS supplier directory.

Forest County Potawatomi Community

DMEPOS supplier · Crandon, WI
✔

Accepts Medicare assignment

Forest County Potawatomi Community agrees to accept the Medicare-approved amount as full payment for covered equipment and supplies. Medicare patients are not billed beyond the standard deductible and coinsurance.

PTAN (Medicare Supplier Number)20627519
Medicare Participant SinceJuly 24, 2000
Supplier Location8201 Mish Ko Swen DrCrandon, WI 54520
Phone(715) 478-4300
Provider TypeIndian Health Service · Physician – Podiatry

Medicare Product Categories

Canes and/or Crutches
Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
Orthoses: Prefabricated (Non-Custom Fabricated)
Met pads, Heel pads, Heel spur pads
Orthoses: Off-The-Shelf
Met pads, Heel pads, Heel spur pads
Urological Supplies
Catheters, Urinary collection devices
Nebulizer Equipment and/or Supplies
Nebulizers, Atomizers, Filters
Oxygen Equipment and/or Supplies
Portable oxygen systems, Oxygen concentrators, Oxygen contents
Product categories are from the Medicare DMEPOS supplier directory. Contact the supplier to confirm current availability of specific items.

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 Forest County Potawatomi Health & Wellness Center's NPI number?

The NPI number for Forest County Potawatomi Health & Wellness Center is 1376650499. It was assigned to this organization in the NPPES registry on August 24, 2006.

Where is Forest County Potawatomi Health & Wellness Center located?

Forest County Potawatomi Health & Wellness Center is located at 8201 Mish Ko Swen Dr, Crandon, WI 54520. The listed phone number is (715) 478-4300.

What is Forest County Potawatomi Health & Wellness Center's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Forest County Potawatomi Health & Wellness Center enrolled in Medicare?

Yes. Forest County Potawatomi Health & Wellness Center is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Forest County Potawatomi Health & Wellness Center?

According to the CMS Revalidation Reassignment List (October 2026 release), 31 clinicians in 13 Medicare specialties reassign their Medicare billing to Forest County Potawatomi Health & Wellness Center. 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 (7), Clinical Social Worker (4) and Optometry (4). Of these, 8 practice at this address and 13 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Forest County Potawatomi Health & Wellness Center accept Medicare assignment for medical equipment?

Yes. As a Medicare medical equipment supplier, Forest County Potawatomi Community accepts Medicare assignment: the supplier accepts the Medicare-approved amount as payment in full for covered equipment and supplies.

Does Forest County Potawatomi Health & Wellness Center hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 52D0678081) is associated with this NPI, valid through May 17, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Forest County Potawatomi Health & Wellness Center was last updated on December 9, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.