LAKE SUPERIOR STATE UNIVERSITY
NPI 1467454199
Family Medicine in Sault Sainte Marie, MI
About Lake Superior State University NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LAKE SUPERIOR STATE UNIVERSITY (NPI 1467454199) is a healthcare organization registered as a family medicine in Sault Sainte Marie, Michigan and active in the NPI registry since August 2005. The organization holds a CLIA Waiver certificate valid through January 11, 2028 and lists Kenneth Peress, Vice President Student Affairs, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 3
Other Identifiers 1
Group Practice 1
Accepted 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)
Lake Superior State University is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
2Medicare enrollment records show 2 clinicians reassign Medicare billing to Lake Superior State University, which bills Medicare for the services they deliver. Of these, 1 practice within 10 miles. They are listed nearest first.
Clinicians, nearest first (2)
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 Waiver 23D0381932
Lake Superior State University Health Care Center · Sault Sainte Marie, MIFrequently 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 Lake Superior State University's NPI number?
The NPI number for Lake Superior State University is 1467454199. It was assigned to this organization in the NPPES registry on August 12, 2005.
Where is Lake Superior State University located?
Lake Superior State University is located at 650 W Easterday Ave, Sault Sainte Marie, MI 49783. The listed phone number is (906) 635-2110.
What is Lake Superior State University's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Lake Superior State University enrolled in Medicare?
Yes. Lake Superior State University is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Lake Superior State University?
According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians, all in Nurse Practitioner, reassign their Medicare billing to Lake Superior State University. 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. Of these, 1 practice within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Lake Superior State University hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D0381932) is associated with this NPI, valid through January 11, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Lake Superior State University accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Lake Superior State University 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 Lake Superior State University was last updated on December 12, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 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.
# Lake Superior State University · NPI 1467454199
Family Medicine organization in Sault Sainte Marie, Michigan. Organization record, active in the CMS NPPES registry since August 12, 2005.
## Identity
- **NPI:** 1467454199 (Entity type: Organization)
- **Enumerated:** August 12, 2005
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Kenneth Peress, VICE PRESIDENT STUDENT AFFAIRS
## Practice location
- **Address:** 650 W EASTERDAY AVE, Sault Sainte Marie, MI 49783-1656
- **Phone:** (906) 635-2110
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 2 clinicians (Nurse Practitioner) reassign Medicare billing to this organization (form CMS-855R); 1 practice within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** December 12, 2008
- **Other identifiers:** Medicare PIN 0P11440 (MI)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1467454199) · Data from the CMS NPPES public registry.