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Midmichigan Health Services

Organization Active NPI Federally Qualified Health Center (FQHC) · Beaverton, MI

NPI 1114278140 · NPPES record last updated May 20, 2014

Key facts

NPI
1114278140
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
MIDMICHIGAN HEALTH SERVICES
Practice address
439 S Ross St
Beaverton, MI 48612-9101
Phone
(989) 246-3500
Fax
(989) 246-3519
NPI assigned
Oct 1, 2012
Organization subpart
No

Authorized official

Name
James P Raschke, MBA
Title
Executive Director
Phone
(989) 422-5122

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 5

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

Other NPIs with the same Medicare PAC ID 6

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 27

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2036102Midmichigan Medical Offices Beaverton
439 S Ross Street, Beaverton, MI 48612		Certificate of waiverJan 31, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

Federally qualified health center certification: CCN 231987

Legal name
MIDMICHIGAN HEALTH SERVICES
Doing business as
MIDMICHIGAN MEDICAL OFFICES BEAVERTON
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 7, 2012
Last certification
Dec 7, 2012
Ownership / control type
For profit – corporation
Organization structure
Other · Non-profit
Enrollment address
439 S Ross St
Beaverton, MI 48612-9101

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Dawn M Lacasse
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2007
Deborah S Vanwert
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2010
Raymond H Stover
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2012
Frederick F Roemer
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2005
Edward F Stern
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2023 100%
Shannon E Phelps
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2012
James P Raschke
Individual 		Corporate Officer
Ceo		 Apr 1, 2024 100%
Bryan R Cross
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2023 100%
William Collin
Individual 		Corporate Officer
Cfo		 Jan 1, 2016 100%
Jeffrey B Fossitt
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 1990
Thomas J Moreau
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2007
Robert Patrick McMorrow
Individual 		Corporate Officer
Chief Medical Officer		 Jul 22, 2019 100%
Lenard S Govitz
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2020 100%
Melissa J Dunkle
Individual 		Corporate Officer
Ceo		 Sep 1, 2023
W-2 Managing Employee Sep 1, 2023
Gregory H Rogers
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2016 100%
Jennifer Shamel
Individual 		Corporate Officer
Coo		 Dec 1, 2020 100%
Midmichigan Health Services
Organization · Houghton Lake, MI
Created for acquisition, Non-profit 		5% Or Greater Direct Ownership Interest Nov 1, 2012 100%
James C Bischoff
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 1997
Joseph Passalacqua
Individual 		Corporate Director
Board of Directors Member		 Jan 1, 2020 100%

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Coleman School Based Health Center
Coleman, MI · CCN C71027		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 9, 2024
Beaverton School Wellness Center
Beaverton, MI · CCN C71033		 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 27, 2024

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040130001007 MI Part B Supplier - Clinic/Group Practice 7911800495 Receives reassigned benefits from 38 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Beaverton, MI; Houghton Lake, MI; Midland, MI; Roscommon, MI; West Branch, MI
O20121025000113 MI Part a Provider - Federally Qualified Health Center (FQHC) 7911800495 Practice locations: Beaverton, MI

National Provider Directory

Locations

439 S Ross St
Beaverton, MI 48612
Phone (989) 246-3500

Specialties & licenses

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

Addresses

Primary practice location

439 S Ross St
Beaverton, MI 48612-9101

Mailing address

9249 W Lake City Rd
Houghton Lake, MI 48629-9602
Phone (989) 422-5122

Other names

  • MIDMICHIGAN MEDICAL OFFICES-BEAVERTON Doing business as

Other providers in Beaverton, MI

All providers in Beaverton, MI · Federally Qualified Health Center (FQHC) in Michigan

Sources for this page

Verify at the official NPI Registry.