Individual provider Active NPI

Carmine Mazzuca, ACNPC-AG

  • Critical Care Medicine Nurse Practitioner
  • Sault Sainte Marie, MI
National Provider Identifier
1003605064
Registry record updated Oct 2, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Care Medicine Nurse PractitionerTaxonomy code 363LC0200X
License
4704214883 Issued in MI
Practice address
500 Osborn Blvd
Sault Sainte Marie, MI 49783-1822
Phone
(906) 635-4460
NPI assigned
May 5, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 2, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Nurse Practitioner 363LC0200X 4704214883 MI Primary

Addresses

Primary practice location

500 Osborn Blvd
Sault Sainte Marie, MI 49783-1822

Mailing address

4000 Wellness Dr
Midland, MI 48670-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250603000506 MI Practitioner - Nurse Practitioner 8729597638 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical Center MidlandGroup PAC ID 2264323633, 507 clinicians
Mymichigan Medical Center SaultGroup PAC ID 7315936481, 101 clinicians

Practice addresses (Care Compare)

4100 Campus Ridge Dr
Midland, MI 48640-6139
Phone (989) 839-1795

500 Osborn Blvd
Sault S Marie, MI 49783-1822
Phone (906) 635-4460

Hospital & facility affiliations

  • Chippewa County War Memorial Hospital Hospital, Sault Ste Marie, MI, CCN 230239
  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Sault CurrentSince May 22, 2025 Accepting new patients
Mymichigan Medical Center Midland CurrentSince May 22, 2025 Accepting new patients
Mymichigan Medical Center Midland CurrentSince May 22, 2025 Accepting new patients
Mymichigan Medical Center Sault CurrentSince May 22, 2025 Accepting new patients
Mymichigan Medical Center Sault Current Accepting new patients

Locations

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

4100 Campus Ridge Dr
Midland, MI 48640
Phone (989) 488-5450

4500 N Campus Ridge Dr
Midland, MI 48640
Phone (989) 837-9250

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759363200000",
    "number": "1003605064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486701000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497831822",
            "telephone_number": "906-635-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZUCA",
        "first_name": "CARMINE",
        "credential": "ACNPC-AG",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-05-05",
        "last_updated": "2025-10-02",
        "certification_date": "2025-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "MI",
            "license": "4704214883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.