Shoshone Bannock Tribes, Inc
NPI 1225414519 · Clinic/Center · Fort Hall, ID
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Provider details
- NPI number
- 1225414519
- Entity type
- Organization
- Primary specialty
- Clinic/CenterAmbulatory Health Care Facilities
- Organization subpart
- No
- Authorized official
- Melissa Johnson, Credentialing Manager(517) 896-3464
Specialties & taxonomies
Ambulatory Health Care Facilities
- Federally Qualified Health Center (FQHC)261QF0400X
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
10 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Shoshone-Bannock Community Health Center
Registry dates
- Enumerated
- 2015-08-10
- Last updated
- 2022-01-19
- Certified
- 2022-01-19
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.