Deckerville Community Hospital, Inc
Organization Active NPI Clinic/Center · Port Sanilac, MI
NPI 1013799469 · NPPES record last updated Dec 14, 2023
Key facts
- NPI
- 1013799469
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinic/Center 261Q00000X
- Legal business name
- DECKERVILLE COMMUNITY HOSPITAL, INC
- Practice address
- 245 S Ridge St
Port Sanilac, MI 48469-9704 - Phone
- (810) 376-2835
- NPI assigned
- Oct 19, 2023
- Organization subpart
- Yes
- Parent organization (as reported)
- DECKERVILLE COMMUNITY HOSPITAL, INC
Authorized official
- Name
- Angela McConnachie
- Title
- Ceo
- Phone
- (989) 635-4000
Other NPIs on the same Medicare enrollment 2
Corporate family (same tax ID) 4
Related certifications (CCN) 3
Practitioners 142
-
Faraaz Ahmed, MD
-
Mohomad Al Sawah, DPM
-
Amer M Alame, M.D.
-
Rashid Alsabeh, M.D.
-
Majed Alzahabi, DO
-
Evan Berg, DO
-
Neal Bhatt, M.D.
-
Sherry Lynn Bombardo, CRNA
-
Makayla Linn Brindley, FNP-BC
-
Gregory Brown, PA-C
-
John M Buday, M.D.
-
Sarah Elizabeth Buhl, AGPCNP
-
Nick Buttar, M.D.
-
Joseph Nino Carlier, D.O.
-
Robert L. Chadwick, D.O.
-
Keith Cronovich, D.O.
Affiliated clinicians 62
-
Faraaz Ahmed, MD
-
Majed Alzahabi, DO
-
Farrukh Anwar, MD
-
Gaurav Bhalla, M.D.
-
Makayla Linn Brindley, FNP-BC
-
Nick Buttar, M.D.
-
Alex Dandashly, DPM
-
Keith Davidson, NP-C
-
Andrew Dolehanty, DO
-
Carrie V Eugster, NP-C
-
Jayson Field, MD
-
Christina George, D.O
-
Geri Lynn Grossi, NP
-
James Michael Hecksel, D.O.
-
Scott M Heithoff, D.O.
-
Stephen Holihan, MD
-
Anubhav Jain, M.B.B.S, M.D.
-
Kimberley James, FNP-C
-
Jennifer C Jones, FNP-C
Medicare Care Compare: Hospital
- Listed as
- Deckerville Community Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Hospital certification: CCN 231311
- Legal name
- DECKERVILLE COMMUNITY HOSPITAL INC
- Doing business as
- DECKERVILLE COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Aug 9, 2000
- Last certification
- Dec 17, 2020
- Beds
- 15
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Incorporated
- Sep 4, 1968 in MI
- Enrollment address
- 3559 Pine St
Deckerville, MI 48427-7703
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Gentner |
Corporate Officer |
Apr 1, 2016 | |
| W-2 Managing Employee |
Apr 1, 2015 | ||
| Victoria Meiburg |
Corporate Director |
May 10, 2022 | |
| Gail Ann Denton |
Corporate Director |
Sep 10, 2018 | |
| Angela McConnachie |
Corporate Officer |
Jan 1, 2023 | |
| Alexander Messing |
Corporate Director |
May 10, 2022 | |
| Tiffany Messing |
W-2 Managing Employee | Jan 1, 2015 | |
| Justin Faber |
Corporate Director |
Sep 8, 2020 | |
| Scott Orr |
Corporate Director |
Sep 1, 2018 | |
| Curtis Landrith |
Corporate Director |
Sep 8, 2020 | |
| Sue Cook |
Corporate Director |
May 11, 2021 | |
| David Messing |
Corporate Director |
Jan 1, 2015 | |
| Irene Cole |
Corporate Director |
Jan 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080321000183 | MI | Part a Provider - Critical Access Hospital | 2163508821 |
Receives reassigned benefits from 163 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Port Sanilac, MI; Deckerville, MI |
National Provider Directory
- Tax ID family
- Deckerville Com Hosp ER
- Part of
- Deckerville Com Hosp ER
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Yes |
Addresses
Primary practice location
245 S Ridge St
Port Sanilac, MI 48469-9704
Mailing address
PO Box 126
Deckerville, MI 48427-0126
Other names
- Port Sanilac Healthcare
Other providers in Port Sanilac, MI
- Faraaz Ahmed
- Philip George Berent
- Amanda Leigh Cayce
- Bryson Cutlip
- Emotional Evolution LLC
- Mark E. English
- Happy Home Companions
- Tyler Kenneth Hayward
- Alex Andrea Hogue
All providers in Port Sanilac, MI · Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.