NPIMap

Organization Active NPI

Northwest Michigan Health Services, Inc

  • Federally Qualified Health Center (FQHC)
  • Traverse City, MI
National Provider Identifier
1144645250
Registry record updated Mar 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
NORTHWEST MICHIGAN HEALTH SERVICES, INC
Practice address
10767 E Traverse Hwy
Traverse City, MI 49684-6219
Phone
(231) 947-1112
Fax
(231) 947-7739
NPI assigned
Feb 26, 2014
Last updated
Mar 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2024

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

Authorized official

Name
Heidi Mae Britton
Title
Chief Executive Officer
Phone
(231) 947-1112

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

10767 E Traverse Hwy
Traverse City, MI 49684-6219

Mailing address

10767 E Traverse Hwy
Traverse City, MI 49684-6219
Phone (231) 947-1112

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140402001268 MI Part A Provider - Federally Qualified Health Center (FQHC) 6608007729 Practice locations: Traverse City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144645250. Details of each certification follow.

Federally qualified health center certification: CCN 231031

Legal name
NORTHWEST MICHIGAN HEALTH SERVICES INC
Doing business as
NORTHWEST MICHIGAN HEALTH SERVICES INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 7, 2014
Last certification
May 7, 2014
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
10767 E Traverse Hwy
Traverse City, MI 49684-6219

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Northwest Michigan Health Services Inc14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Locations

3954 Silver Lake Rd
Traverse City, MI 49684
Phone (231) 642-5291

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Dalia Estrada Individual Corporate DirectorBoard Member Oct 1, 2022
Karen M Goodman Individual Corporate Director Apr 1, 2021
Rochelle a Radlinski Individual Corporate DirectorSecretary Jun 1, 2012
Jose Edson Pontes Individual Corporate Director Feb 24, 2019
Mindy M Aguilar Individual W-2 Managing EmployeeDirector of Human Resources Jun 10, 2013
Fernando Meza Individual Corporate Director Oct 1, 2016
Larry K Vansickle Individual Corporate OfficerTreasurer of Board Jun 8, 2005
Lauren Flynn Individual Corporate DirectorBoard Member Nov 1, 2023
Meghan J Davis Individual Corporate Director Sep 1, 2023
Callie Barr Individual Corporate DirectorBoard Member Nov 1, 2023
Lisa Allen Individual Corporate DirectorVice President Oct 1, 2022
Kirk E Myers Individual Corporate OfficerPresident of Board Mar 11, 2008
Heidi M Britton Individual Corporate OfficerChief Executive Officer Jul 28, 2014
Operational/Managerial ControlChief Executive Officer Jul 28, 2014
David a Wild Individual Corporate DirectorBoard Member Aug 1, 2012

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 22

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 22

NPI Registry JSON

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710201600000",
    "number": "1144645250",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10767 E TRAVERSE HWY",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846219",
            "telephone_number": "231-947-1112",
            "fax_number": "231-947-7739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10767 E TRAVERSE HWY",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846219",
            "telephone_number": "231-947-1112",
            "fax_number": "231-947-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHWEST MICHIGAN HEALTH SERVICES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-26",
        "last_updated": "2024-03-12",
        "certification_date": "2024-03-12",
        "status": "A",
        "authorized_official_last_name": "BRITTON",
        "authorized_official_first_name": "HEIDI",
        "authorized_official_middle_name": "MAE",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "231-947-1112"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.