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Organization Active NPI

Dickinson County Healthcare System

Doing business as Dickinson Pulmonology Clinic

  • Pulmonary Disease Physician
  • Iron Mountain, MI
National Provider Identifier
1043635378
Registry record updated Mar 13, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
DICKINSON COUNTY HEALTHCARE SYSTEM
Doing business as
Dickinson Pulmonology Clinic
Practice address
1711 S Stephenson Ave
Suite 125
Iron Mountain, MI 49801-3639
Phone
(906) 776-5930
Fax
(906) 776-5901
NPI assigned
Feb 24, 2014
Last updated
Mar 13, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2014

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

Authorized official

Name
Alicia Henderson, CPC, CCP
Title
Physician Billing Supervisor
Phone
(906) 776-5665

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X Primary

Addresses

Primary practice location

1711 S Stephenson Ave
Suite 125
Iron Mountain, MI 49801-3639

Mailing address

PO Box 549
Iron Mountain, MI 49801-0549
Phone (906) 776-5930

Other names 1

  • Dickinson Pulmonology Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040310000583 MI Part B Supplier - Clinic/Group Practice 6800784943 Receives reassigned benefits from 156 practitioners
27 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Skandia, MI; Novi, MI; Munising, MI; Marquette, MI; Kingsford, MI; Ishpeming, MI; Iron River, MI; Iron Mountain, MI…
O20050623000153 MI Part B Supplier - Clinic/Group Practice 6800784943 Receives reassigned benefits from 13 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Iron Mountain, MI; Norway, MI; Marquette, MI; Kingsford, MI; Ishpeming, MI; Iron River, MI; Bark River, MI

Other NPIs on the same Medicare enrollment 20

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

View all 20

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1393200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1394668800000",
    "number": "1043635378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498010549",
            "telephone_number": "906-776-5930",
            "fax_number": "906-776-5901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S STEPHENSON AVE",
            "address_2": "SUITE 125",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498013639",
            "telephone_number": "906-776-5930",
            "fax_number": "906-776-5901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKINSON COUNTY HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-24",
        "last_updated": "2014-03-13",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PHYSICIAN BILLING SUPERVISOR",
        "authorized_official_telephone_number": "906-776-5665",
        "authorized_official_credential": "CPC, CCP"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickinson Pulmonology Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Iron Mountain, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; 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.