NPIMap

Organization Active NPI

Family Medical Center of Michigan,Inc

Doing business as Family Medical Center-Monroe Main

  • Federally Qualified Health Center (FQHC)
  • Monroe, MI
National Provider Identifier
1023655149
Registry record updated Dec 9, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY MEDICAL CENTER OF MICHIGAN,INC
Doing business as
Family Medical Center-Monroe Main
Practice address
901 N Macomb St
Monroe, MI 48162-3088
Phone
(734) 639-2546
Fax
(734) 639-2552
NPI assigned
Dec 9, 2019
Last updated
Dec 9, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2019

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

Authorized official

Name
Mr. Ed Larkins
Title
Ceo
Phone
(734) 850-6915

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

901 N Macomb St
Monroe, MI 48162-3088

Mailing address

8765 Lewis Ave
Temperance, MI 48182-9583
Phone (734) 850-6903

Other names 1

  • Family Medical Center-Monroe Main Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20070910000059 MI Part B Supplier - Clinic/Group Practice 2769575653 Receives reassigned benefits from 35 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adrian, MI; Carleton, MI; Monroe, MI; Temperance, MI
O20200213001119 MI Part A Provider - Federally Qualified Health Center (FQHC) 2769575653 Practice locations: Monroe, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1023655149. Details of each certification follow.

Federally qualified health center certification: CCN 231154

Legal name
FAMILY MEDICAL CENTER OF MICHIGAN INC
Doing business as
FAMILY MEDICAL CENTER MONROE MAIN
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 11, 2020
Last certification
Feb 11, 2020
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
901 N Macomb St
Monroe, MI 48162-3088

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory
Tax ID family
Family Medical Center O93 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 13

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 13

Locations

1200 N Main St
Adrian, MI 49221
Phone (517) 263-1800

690 Riverside Ave
Adrian, MI 49221
Phone (517) 263-7118

11330 Grafton Rd
Rm 112
Carleton, MI 48117

1085 N Macomb St
Monroe, MI 48162
Phone (734) 241-1900

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
Ada Rodriguez Individual Corporate DirectorBoard of Directors Mar 1, 2025
Ed Larkins Individual Corporate OfficerCeo Mar 22, 2004
Corporate DirectorCeo Mar 22, 2004
Operational/Managerial ControlCeo Mar 22, 2004
Shirley Elaine Troxell - Robson Individual Corporate DirectorBoard of Director Jul 1, 2011
Walter Tylicki Individual Corporate DirectorBoard of Director Jan 3, 2000
Charles Watkins Individual Corporate DirectorBoard of Director Jun 1, 2006
David Brown Individual Corporate DirectorBoard of Director Dec 1, 1987
Alma Salyer Individual Corporate DirectorBoard of Director Jan 3, 1995
Burt Fenby Individual Corporate DirectorBoard of Director Sep 1, 2009
John Langer Individual Corporate DirectorBoard of Director Apr 1, 2013
Kathleen Virginia Vanetten Individual Corporate DirectorBoard of Directors Mar 21, 2020
Christina Wright Individual Corporate DirectorBoard of Directors Mar 1, 2023
Kathleen a Busen Individual Corporate DirectorBoard of Director Jun 1, 1997

Practitioners & affiliated clinicians

Practitioners 49

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 49

NPI Registry JSON

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

{
    "created_epoch": "1575849600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575849600000",
    "number": "1023655149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 LEWIS AVE",
            "city": "TEMPERANCE",
            "state": "MI",
            "postal_code": "481829583",
            "telephone_number": "734-850-6903",
            "fax_number": "734-850-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481623088",
            "telephone_number": "734-639-2546",
            "fax_number": "734-639-2552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER OF MICHIGAN,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-09",
        "last_updated": "2019-12-09",
        "certification_date": "2019-12-09",
        "status": "A",
        "authorized_official_last_name": "LARKINS",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-850-6915",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Center-Monroe Main",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.