{"npi":"1306832894","type":"NPI-2","status":"active","name":{"display":"Sawtooth Mountain Clinic, Inc.","other":[],"organization_name":"SAWTOOTH MOUNTAIN CLINIC, INC.","authorised_official":"Jeff Stoddard"},"specialty":{"primary_taxonomy":"261QF0400X","primary_taxonomy_description":"Federally Qualified Health Center","slug":"fqhc","schema_org_specialty":"PrimaryCare","all":[{"code":"1041C0700X","description":"Clinical Social Worker","primary":false,"state":"MN","license":"22021"},{"code":"207Q00000X","description":"Family Medicine","primary":false,"state":null,"license":null},{"code":"261QF0400X","description":"Federally Qualified Health Center","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"513 5TH AVE W","city":"GRAND MARAIS","state":"MN","postal_code":"556043017","country_code":"US","phone":"2183872330","fax":"2183871278"},{"purpose":"MAILING","street_1":"513 5TH AVE W","city":"GRAND MARAIS","state":"MN","postal_code":"556043017","country_code":"US","phone":"2183872330","fax":"2183871278"}],"license":null,"identifiers":[{"type_code":"05","label":"Medicaid","value":"536253900","state":"MN","issuer":null},{"type_code":"01","label":"Other","value":"BC69144CO","state":"MN","issuer":"GROUP CLAIMS-BCBS"},{"type_code":"05","label":"Medicaid","value":"785090500","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"744708600","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"844318100","state":"MN","issuer":null},{"type_code":"01","label":"Other","value":"241806","state":"MN","issuer":"MEDICARE/OSCAR CERTIFICATION"},{"type_code":"05","label":"Medicaid","value":"873397000","state":"MN","issuer":null},{"type_code":"05","label":"Medicaid","value":"639097800","state":"MN","issuer":null},{"type_code":"01","label":"Other","value":"4F029TE","state":"MN","issuer":"DR. TERRILL-BCBS"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20031017000011","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MN","pac_id":"8224940010"},{"enrlmt_id":"O20041103000490","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"MN","pac_id":"8224940010"},{"enrlmt_id":"O20250314000532","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MN","pac_id":"8224940010"},{"enrlmt_id":"O20250314000674","type_code":"00-04","type_desc":"PART A PROVIDER - FEDERALLY QUALIFIED HEALTH CENTER (FQHC)","state":"MN","pac_id":"8224940010"}]},"enumeration_date":"2005-09-21","last_updated":"2025-01-03","_meta":{"source":"NPPES","snapshot_date":"2025-01-03","doc_url":"https://findmynpi.com/api"}}