Organization Active NPI

Jonesville Health Care PLLC

  • Family Medicine Physician
  • Jonesville, MI
National Provider Identifier
1063573830
Registry record updated Sep 9, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
JONESVILLE HEALTH CARE PLLC
Practice address
216 Olds St
Jonesville, MI 49250-1128
Phone
(517) 849-7100
Fax
(517) 849-2453
NPI assigned
Dec 13, 2006
Last updated
Sep 9, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2014

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

Authorized official

Name
Mrs. Sheila K McMullen
Title
Manager
Phone
(517) 849-7100

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

216 Olds St
Jonesville, MI 49250-1128

Mailing address

216 Olds St
Jonesville, MI 49250-1128
Phone (517) 849-7100

Other identifiers 12

IdentifierTypeStateIssuer
0153000175OtherMIBLUE CROSS
7559446OtherMIAETNA
P117885OtherMIBCN
0120255OtherMIPHP
143119OtherMIGREAT LAKES
114511135MedicaidMI
143115OtherMIGREAT LAKES
P30270FOtherMIBCN
0153000155OtherMIBLUE CROSS
114516211MedicaidMI
0120256OtherMIPHP
7537437OtherMIAETNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031201000619 MI Part B Supplier - Clinic/Group Practice 8426953696 Receives reassigned benefits from 8 practitioners
Practice locations: Jonesville, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1022773Jonesville Health Care PLLC216 Olds Street, Jonesville, MI 49250Certificate of waiverFeb 24, 2028

National Provider Directory

National Provider Directory

Locations

206 Olds St
Jonesville, MI 49250
Phone (517) 849-7100

216 Olds St
#M99
Jonesville, MI 49250
Phone (517) 849-7100

Practitioners & affiliated clinicians

Practitioners 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1410220800000",
    "number": "1063573830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "216 OLDS ST",
            "city": "JONESVILLE",
            "state": "MI",
            "postal_code": "492501128",
            "telephone_number": "517-849-7100",
            "fax_number": "517-849-2453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "216 OLDS ST",
            "city": "JONESVILLE",
            "state": "MI",
            "postal_code": "492501128",
            "telephone_number": "517-849-7100",
            "fax_number": "517-849-2453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JONESVILLE HEALTH CARE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2014-09-09",
        "status": "A",
        "authorized_official_last_name": "MCMULLEN",
        "authorized_official_first_name": "SHEILA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "517-849-7100",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0153000175",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7559446",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P117885",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "0120255",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES",
            "identifier": "143119",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114511135",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES",
            "identifier": "143115",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P30270F",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "0153000155",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "114516211",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP",
            "identifier": "0120256",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7537437",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jonesville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.