NPIMap

Organization Active NPI

Deckerville Community Hospital, Inc

Doing business as Port Sanilac Healthcare

  • Clinic/Center
  • Port Sanilac, MI
National Provider Identifier
1013799469
Registry record updated Dec 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DECKERVILLE COMMUNITY HOSPITAL, INC
Doing business as
Port Sanilac Healthcare
Practice address
245 S Ridge St
Port Sanilac, MI 48469-9704
Phone
(810) 376-2835
NPI assigned
Oct 19, 2023
Last updated
Dec 14, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DECKERVILLE COMMUNITY HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2023

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

Authorized official

Name
Angela McConnachie
Title
Ceo
Phone
(989) 635-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

245 S Ridge St
Port Sanilac, MI 48469-9704

Mailing address

PO Box 126
Deckerville, MI 48427-0126

Other names 1

  • Port Sanilac Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013799469. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Sep 4, 1968 in MI
Enrollment address
3559 Pine St
Deckerville, MI 48427-7703
Other Hospital Practice Location

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Deckerville Community HospitalCCN 231311 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Deckerville Community Inc5 organizations share this tax ID, including this one
Part of
Deckerville Community Inc

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Kimberly Gentner Individual Corporate OfficerCfo Apr 1, 2016
W-2 Managing EmployeeDirector of Finance Apr 1, 2015
Victoria Meiburg Individual Corporate DirectorBoard of Directors Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorBoard of Directors, Member Sep 10, 2018
Angela McConnachie Individual Corporate OfficerCeo Jan 1, 2023
Alexander Messing Individual Corporate DirectorBoard of Directors Member May 10, 2022
Tiffany Messing Individual W-2 Managing Employee Jan 1, 2015
Justin Faber Individual Corporate DirectorBoard of Directors, Member Sep 8, 2020
Scott Orr Individual Corporate DirectorBoard of Directors, Member Sep 1, 2018
Curtis Landrith Individual Corporate DirectorBoard of Directors, Member Sep 8, 2020
Sue Cook Individual Corporate DirectorBoard of Directors Member May 11, 2021
David Messing Individual Corporate DirectorBoard of Directors, Member Jan 1, 2015
Irene Cole Individual Corporate DirectorBoard of Directors, Member Jan 1, 2017

Practitioners & affiliated clinicians

Practitioners 142

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 142

Affiliated clinicians 62

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702512000000",
    "number": "1013799469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 126",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484270126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S RIDGE ST",
            "city": "PORT SANILAC",
            "state": "MI",
            "postal_code": "484699704",
            "telephone_number": "810-376-2835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKERVILLE COMMUNITY HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DECKERVILLE COMMUNITY HOSPITAL, INC",
        "enumeration_date": "2023-10-19",
        "last_updated": "2023-12-14",
        "certification_date": "2023-12-14",
        "status": "A",
        "authorized_official_last_name": "MCCONNACHIE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-635-4000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Sanilac Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Sanilac, MI

Sources for this page

Verify at the official NPI Registry.