NPIMap

Organization Active NPI

East Jordan Family Health Center

  • Federally Qualified Health Center (FQHC)
  • East Jordan, MI
National Provider Identifier
1114958691
Registry record updated Dec 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
EAST JORDAN FAMILY HEALTH CENTER
Practice address
601 Bridge St
East Jordan, MI 49727-9383
Phone
(231) 536-2206
Fax
(231) 536-9864
NPI assigned
Jul 5, 2006
Last updated
Dec 22, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2025

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

Authorized official

Name
Mr. Daniel McKinnon
Title
Ceo
Phone
(231) 536-2206

Specialties & licenses 1

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

Addresses

Primary practice location

601 Bridge St
East Jordan, MI 49727-9383

Mailing address

601 Bridge St
East Jordan, MI 49727-9383
Phone (231) 536-2206

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040210000099 MI Part B Supplier - Clinic/Group Practice 8325932510 Receives reassigned benefits from 28 practitioners
2 other NPIs on this enrollment
Practice locations: Bellaire, MI; Central Lake, MI; East Jordan, MI
O20080812000646 MI Part A Provider - Federally Qualified Health Center (FQHC) 8325932510 Practice locations: East Jordan, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1114958691. Details of each certification follow.

Federally qualified health center certification: CCN 231803

Legal name
EAST JORDAN FAMILY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 1, 1992
Last certification
Apr 1, 1992
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Oct 5, 1976 in MI
Enrollment address
601 Bridge St
East Jordan, MI 49727-9383

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cara Griffiths Individual Corporate Officer Jun 1, 2019
Timothy Kish Individual Corporate Officer Jun 1, 2019
Daniel McKinnon Individual Corporate DirectorExecutive Director Aug 1, 2007
W-2 Managing Employee Aug 1, 2007
Brian D Olszewski Individual Corporate OfficerTreasurer Mar 23, 2021
Patricia Savant Individual Corporate Officer Jun 1, 2019
Mary Ann Scott Individual Corporate Officer Jun 1, 2019
Janelle Kassien Individual Corporate OfficerPresident-Board of Directors Jun 1, 2019

Practitioners & affiliated clinicians

Practitioners 29

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 29

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766361600000",
    "number": "1114958691",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 BRIDGE ST",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279383",
            "telephone_number": "231-536-2206",
            "fax_number": "231-536-9864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 BRIDGE ST",
            "city": "EAST JORDAN",
            "state": "MI",
            "postal_code": "497279383",
            "telephone_number": "231-536-2206",
            "fax_number": "231-536-9864"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EAST JORDAN FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-12-22",
        "certification_date": "2025-12-22",
        "status": "A",
        "authorized_official_last_name": "MCKINNON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "231-536-2206",
        "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": []
}

Other providers in East Jordan, MI

Sources for this page

Verify at the official NPI Registry.