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LAKE SUPERIOR STATE UNIVERSITY
NPI 1467454199
Family Medicine in Sault Sainte Marie, MI

Active since August 12, 2005CLIA 23D0381932 · Waiver
650 W EASTERDAY AVE, SAULT SAINTE MARIE, MI 49783(906) 635-2110 Get Directions Write a Review

NPPES record last updated: December 12, 2008. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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

NPI1467454199
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameLAKE SUPERIOR STATE UNIVERSITY
Location Address650 W EASTERDAY AVESault Sainte Marie, MI 49783-1656
Mailing Address650 W Easterday AveSault Sainte Marie, MI 49783-1656 · (906) 635-2110
Phone(906) 635-2110
Organization SubpartNo
Authorized OfficialKenneth PeressVice President Student Affairs · (906) 635-2634
Enumeration DateAugust 12, 2005
Last NPPES UpdateDecember 12, 2008
✔ NPI 1467454199 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedPhysician AssistantTaxonomy 363A00000X
Also ListedNurse PractitionerTaxonomy 363L00000X
650 W EASTERDAY AVE, Sault Sainte Marie, MI 49783
Open in Google Maps ↗

Other Identifiers 1

Medicare PIN0P11440MI

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

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

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, MI
Active · expires Jan 11, 2028
CLIA Number23D0381932
Laboratory TypePhysician Office
Certificate Effective DateJanuary 12, 2026
Certificate Expiration DateJanuary 11, 2028
Laboratory DirectorErin Meehan-Amo
Laboratory Phone(906) 635-2110
Laboratory LocationLake Superior State University Health Care Center621 Easterday Avenue, Sault Sainte Marie, MI 49783
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JOSEPH D. SUSI II MS, ATC
Specialist/Technologist (Athletic Trainer)
650 W EASTERDAY AVE
SAULT SAINTE MARIE, MI 49783
Chippewa County (906) 635-2161
SCOTT MICHAEL BARTZ PA-C
Physician Assistant (Medical)
650 W EASTERDAY AVE
SAULT SAINTE MARIE, MI 49783
Chippewa County (906) 635-2110
ERIN MEEHAN-AMO PA-C
Physician Assistant
650 W EASTERDAY AVE
SAULT SAINTE MARIE, MI 49783
Chippewa County (906) 635-2110
SARAH OUIMETTE AT,ATC,PTA
Physical Therapy Assistant
650 W EASTERDAY AVE
SAULT SAINTE MARIE, MI 49783
Chippewa County (715) 271-2144
ABIGAIL BERKE PARKER NP
Nurse Practitioner
650 W EASTERDAY AVE
SAULT SAINTE MARIE, MI 49783
Chippewa County (906) 635-2418

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 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.

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 with the weekly NPPES data releases published by CMS.