Active NPI
Portage Physician Practices Inc
Doing business as UP Medical Group - Portage Express Care
- Rural Health Clinic/Center
- Calumet, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- Legal business name
- PORTAGE PHYSICIAN PRACTICES INC
- Doing business as
- UP Medical Group - Portage Express Care
- Practice address
- 56720 Calumet Ave Ste B
Calumet, MI 49913-1967 - Phone
- (906) 481-8952
- Fax
- (906) 337-4049
- NPI assigned
- Jun 12, 2023
- Last updated
- Oct 12, 2023
- 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
- Monica Bowman
- Title
- President
- Phone
- (615) 920-7000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Primary |
Addresses
Primary practice location
56720 Calumet Ave Ste B
Calumet, MI 49913-1967
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-5098
Phone (615) 920-7000
Other names 1
- UP Medical Group - Portage Express Care
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131210001058 | MI | Part B Supplier - Clinic/Group Practice | 6103053509 |
Receives reassigned benefits from 150 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Calumet, MI; Hancock, MI; Houghton, MI; Lake Linden, MI |
| O20231018001783 | MI | Part A Provider - Rural Health Clinic | 6103053509 | Practice locations: Calumet, MI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1164106910. Details of each certification follow.
Rural health clinic certification: CCN 238941
- Legal name
- PORTAGE PHYSICIAN PRACTICES INC
- Doing business as
- UP MEDICAL GROUP - PORTAGE EXPRESS CARE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Apr 23, 2024
- Last certification
- Apr 23, 2024
- Ownership / control type
- 1B
- Organization structure
- Corporation
- Enrollment address
- 56720 Calumet Ave
Ste B
Calumet, MI 49913-1905
Other NPIs with the same Medicare PAC ID 2
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Up Medical Group - Portage Express Care
- Rural Health Clinic/Center
- Houghton, MI
- NPI 1376229419
6103053509
Other NPIs on the same Medicare enrollment 3
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Internal Medicine Physician
- Hancock, MI
- NPI 1225461684
O20131210001058
-
dba Up Medical Group - Portage Express Care
- Rural Health Clinic/Center
- Houghton, MI
- NPI 1376229419
O20131210001058
-
dba Portage Health Express Care
- Family Medicine Physician
- Houghton, MI
- NPI 1679902191
O20131210001058
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2077796 | Portage Physician Practices, Inc | Certificate of waiver | May 14, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Portage Physician Pract Inc
Other organizations with this tax ID 4
Organizations that report the same tax identification number in the National Provider Directory.
-
- Rural Health Clinic/Center
- Lake Linden, MI
- NPI 1154758167
-
- Rural Health Clinic/Center
- Hancock, MI
- NPI 1275960064
-
dba Up Medical Group - Portage Express Care
- Rural Health Clinic/Center
- Houghton, MI
- NPI 1376229419
-
- Rural Health Clinic/Center
- Houghton, MI
- NPI 1619304615
Locations
56720 Calumet Ave
Ste B
Calumet, MI 49913
Phone (906) 481-8952
500 Campus Dr
Ste 1
Hancock, MI 49930
Phone (906) 483-1040
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Portage Health Foundation | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 20% |
| Pamela Kane | Corporate Officer | Jul 1, 2023 | |
| Portage Holding Company LLC | 5% Or Greater Direct Ownership Interest | Jul 1, 2023 | 100% |
| DSB Acquisition LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Laura C Hinson | Corporate Officer | Mar 12, 2025 | |
| Lifepoint Hospitals Holdings LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Historic Lifepoint Hospitals, LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Lifepoint Health Inc | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
| Charlotte E Lawrence | Corporate Officer | Jul 1, 2023 | |
| Klaus Michael Boel | Corporate Officer | Aug 19, 2024 | |
| W-2 Managing Employee | Aug 19, 2024 | ||
| John Michael Grooms | Corporate Officer | Jul 1, 2023 | |
| Christopher J Monte | Corporate Officer | Jul 1, 2023 | |
| Legacy Lifepoint Health LLC | 5% Or Greater Indirect Ownership Interest | Jul 1, 2023 | 80% |
Facilities with the same owner 193
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba UP Health System Bell
- Critical Access Hospital
- Ishpeming, MI
- NPI 1699101345
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Bell
- Medicare Defined Swing Bed Hospital Unit
- Ishpeming, MI
- NPI 1760819858
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Medical Group - Bell Women's Care
- Rural Health Clinic/Center
- Ishpeming, MI
- NPI 1114726676
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Marquette
- Rehabilitation Hospital Unit
- Marquette, MI
- NPI 1134474737
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Marquette
- General Acute Care Hospital
- Marquette, MI
- NPI 1568727048
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Marquette
- Psychiatric Hospital Unit
- Marquette, MI
- NPI 1699020289
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Pediatric Specialists
- Rural Health Clinic/Center
- Marquette, MI
- NPI 1205635760
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Family Medicine
- Rural Health Clinic/Center
- Escanaba, MI
- NPI 1679372130
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Home Care and Hospice
- Home Health Agency
- Marquette, MI
- NPI 1457899668
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Hospitals Holdings LLC
-
dba UP Health System Home Care and Hospice Portage
- Home Health Agency
- Houghton, MI
- NPI 1942749726
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Hospitals Holdings LLC
-
dba PortagePointe
- Skilled Nursing Facility
- Hancock, MI
- NPI 1104253921
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Portage Health Foundation, Portage Holding Company LLC
-
dba UP Health System Portage
- General Acute Care Hospital
- Hancock, MI
- NPI 1245667229
Historic Lifepoint Hospitals, LLC, Legacy Lifepoint Health LLC, Lifepoint Holdings 2 LLC, Lifepoint Hospitals Holdings LLC, Portage Health Foundation, Portage Holding Company LLC
Practitioners & affiliated clinicians
Practitioners 150
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.
-
- Physician Assistant
- Fairmont, WV
- NPI 1659626117
-
- Vascular & Interventional Radiology Physician
- Detroit, MI
- NPI 1588871826
-
- Emergency Medicine Physician
- Detroit, MI
- NPI 1760611198
-
- Nurse Practitioner
- Hancock, MI
- NPI 1386049211
-
- Physician Assistant
- Kalkaska, MI
- NPI 1316128754
-
- Medical Physician Assistant
- Grand Rapids, MI
- NPI 1134774524
-
- Family Nurse Practitioner
- Lake Linden, MI
- NPI 1003475344
-
- Emergency Medicine Physician
- Farmington Hills, MI
- NPI 1467571711
-
- Emergency Medicine Physician
- Muskegon, MI
- NPI 1235510843
-
- Orthopaedic Surgery Physician
- Marquette, MI
- NPI 1861403719
-
- Surgery Physician
- Sandusky, MI
- NPI 1912954652
-
- Emergency Medicine Physician
- Hancock, MI
- NPI 1447612577
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1686528000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1697068800000",
"number": "1164106910",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 SEVEN SPRINGS WAY",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275098",
"telephone_number": "615-920-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "56720 CALUMET AVE STE B",
"city": "CALUMET",
"state": "MI",
"postal_code": "499131967",
"telephone_number": "906-481-8952",
"fax_number": "906-337-4049"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PORTAGE PHYSICIAN PRACTICES INC",
"organizational_subpart": "NO",
"enumeration_date": "2023-06-12",
"last_updated": "2023-10-12",
"certification_date": "2023-10-12",
"status": "A",
"authorized_official_last_name": "BOWMAN",
"authorized_official_first_name": "MONICA",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "615-920-7000"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "UP Medical Group - Portage Express Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Calumet, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.