Organization Active NPI

McLaren Bay Region

  • Psychologist
  • Essexville, MI
National Provider Identifier
1013056233
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
MCLAREN BAY REGION
Practice address
1480 W Center Rd
Essexville, MI 48732
Phone
(989) 895-4625
Fax
(989) 895-4626
NPI assigned
Feb 5, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Danielle C Jacks Porter
Title
Cfo
Phone
(989) 894-3838

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1480 W Center Rd
Essexville, MI 48732

Mailing address

1900 Columbus Ave
Bay City, MI 48708-6831
Phone (989) 894-3000

Other identifiers 1

IdentifierTypeStateIssuer
5008702430OtherMIBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040416000730 MI Part B Supplier - Clinic/Group Practice 5597659011 Receives reassigned benefits from 5 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bay City, MI; Essexville, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations (25 of 37)

1900 Columbus Ave
Chicago, IL 60677

1060 S Van Dyke Rd
#200300
Bad Axe, MI 48413

3140 W Professional CT Ste 194
Bay City, MI 48706

1900 Columbus Ave
Unit 2E
Bay City, MI 48708

4 Columbus Ave
Ste 1200
Bay City, MI 48708

820 S Lincoln St
Bay City, MI 48708

1900 Columbus Ave
Fl S
Bay City, MI 48708

4175 N Euclid Ave
Ste 110
Bay City, MI 48706

3175 Professional Ct
Ste 102
Bay City, MI 48706

4 Columbus Ave
Ste 210
Bay City, MI 48708
Phone (989) 249-1922

3180 E Midland Rd
Bay City, MI 48706
Phone (989) 667-6670

3175 Professional Ct
Ste 1
Bay City, MI 48706
Phone (989) 895-4625

3175 Professional Ct
Unit 4
Bay City, MI 48706

3720 Katalin Ct
Ste 201
Bay City, MI 48706
Phone (989) 686-2800

4175 N Euclid Ave
Bay City, MI 48706
Phone (989) 667-2940

3140 W Campus Dr
Ste 194
Bay City, MI 48706
Phone (989) 667-2381

4 Columbus Ave
Ste 250
Bay City, MI 48708
Phone (989) 892-4591

4 Columbus Ave
Ste 160
Bay City, MI 48708
Phone (989) 377-4477

3140 W Campus Dr
Unit 4
Bay City, MI 48706

3175 Professional Ct
Ste 2
Bay City, MI 48706
Phone (989) 316-4010

1456 W Center Rd
Ste 1
Essexville, MI 48732
Phone (989) 895-4840

1480 W Center Rd
Essexville, MI 48732
Phone (989) 895-4625

1480 W Center Rd
Ste 5
Essexville, MI 48732
Phone (989) 894-4625

7340 Midland Rd
Freeland, MI 48623
Phone (989) 695-2123

801 Joe Mann Blvd
Ste A
Midland, MI 48642
Phone (989) 794-4025

Practitioners & affiliated clinicians

Practitioners 104

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 104

NPI Registry JSON

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1013056233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 COLUMBUS AVE",
            "city": "BAY CITY",
            "state": "MI",
            "postal_code": "487086831",
            "telephone_number": "989-894-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1480 W CENTER RD",
            "city": "ESSEXVILLE",
            "state": "MI",
            "postal_code": "48732",
            "telephone_number": "989-895-4625",
            "fax_number": "989-895-4626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN BAY REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-05",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "JACKS PORTER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "989-894-3838"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "5008702430",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Essexville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.