Active NPI
McLaren Bay Region
- Pulmonary Disease Physician
- Bay City, MI
National Provider Identifier
1083974323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pulmonary Disease Physician
- Legal business name
- MCLAREN BAY REGION
- Practice address
- 640 S Trumbull St
Bay City, MI 48708 - Phone
- (989) 893-7460
- NPI assigned
- May 21, 2012
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Danielle C Jacks Porter
- Title
- Cfo
- Phone
- (989) 894-3838
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | |||
| Pulmonary Disease Physician | 207RP1001X | Primary |
Addresses
Primary practice location
640 S Trumbull St
Bay City, MI 48708
Mailing address
640 S Trumbull St
Bay City, MI 48708-7656
Phone (989) 893-7460
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040213000277 | MI | Part B Supplier - Clinic/Group Practice | 5597659011 |
Receives reassigned benefits from 268 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bay City, MI; Essexville, MI; Gladwin, MI; Pigeon, MI; Sterling, MI; Bad Axe, MI |
Other NPIs on the same Medicare enrollment 5
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1337558400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1533686400000",
"number": "1083974323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 S TRUMBULL ST",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487087656",
"telephone_number": "989-893-7460"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 S TRUMBULL ST",
"city": "BAY CITY",
"state": "MI",
"postal_code": "48708",
"telephone_number": "989-893-7460"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MCLAREN BAY REGION",
"organizational_subpart": "NO",
"enumeration_date": "2012-05-21",
"last_updated": "2018-08-08",
"status": "A",
"authorized_official_last_name": "JACKS PORTER",
"authorized_official_first_name": "DANIELLE",
"authorized_official_middle_name": "C",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "989-894-3838"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RP1001X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Internal Medicine, Pulmonary Disease",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bay City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; 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.