NPIMap

Organization Active NPI

Deckerville Community Hospital, Inc.

  • Family Medicine Physician
  • Deckerville, MI
National Provider Identifier
1164540555
Registry record updated Oct 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DECKERVILLE COMMUNITY HOSPITAL, INC.
Practice address
3559 Pine Street
Deckerville, MI 48427
Phone
(810) 376-2835
Fax
(810) 376-9412
NPI assigned
Mar 26, 2007
Organization subpart
Yes
Parent organization
DECKERVILLE COMMUNITY HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 5, 2017

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

Authorized official

Name
Kimberly Gentner
Title
Cfo
Phone
(810) 376-2835

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X

Addresses

Primary practice location

3559 Pine Street
Deckerville, MI 48427

Mailing address

3559 Pine Street
Deckerville, MI 48427
Phone (810) 376-2835

Other identifiers 2

IdentifierTypeStateIssuer
G61003OtherMIBCBSM
138358OtherMIGREAT LAKES HEALTH PLAN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110523000767 MI Part B Supplier - Hospital Department(S) 2163508821 Receives reassigned benefits from 87 practitioners
2 other NPIs on this enrollment
Practice locations: Deckerville, MI
O20130904000878 MI Part A Provider - Rural Health Clinic 2163508821 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deckerville, MI

Rural health clinic certification: CCN 238666

Legal name
DECKERVILLE COMMUNITY HOSPITAL INC
Doing business as
DECKERVILLE HEALTHCARE SERVICES RHC, INC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 27, 2014
Last certification
May 27, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
2030 Black River St
Deckerville, MI 48427-9440
Related CCNs
231311

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Deckerville Com Hosp ER

Locations

2030 Black River St
Deckerville, MI 48427
Phone (810) 376-2835

2433 Black River St
#1
Deckerville, MI 48427

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Kimberly Gentner Individual Corporate OfficerCfo Apr 15, 2016
Victoria Meiburg Individual Corporate DirectorBoard of Directors Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorBoard of Directors, Member Oct 9, 2018
Angela McConnachie Individual Corporate OfficerCoo Feb 1, 2016
Alexander Messing Individual Corporate DirectorBoard of Directors Member May 10, 2022
Tiffany Messing Individual W-2 Managing Employee Jan 1, 2015
Justin Faber Individual Corporate DirectorBoard of Directors, Member Sep 8, 2020
Scott Orr Individual Corporate DirectorBoard of Directors, Member Oct 9, 2018
Curtis Landrith Individual Corporate DirectorBoard of Directors, Member Sep 8, 2020
Daniel Babcock Individual Corporate OfficerCeo Feb 11, 2020
Sue Cook Individual Corporate DirectorBoard of Directors Member May 11, 2021
David West Individual Corporate DirectorBoard of Directors, Member Oct 1, 2016
David Messing Individual Corporate DirectorBoard of Directors, Member Sep 1, 2017
Christopher Clark Individual Corporate DirectorBoard of Directors, Member Oct 9, 2018
Irene Cole Individual Corporate DirectorBoard of Directors, Member Oct 9, 2018

Practitioners & affiliated clinicians

Practitioners 90

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

View all 90

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507161600000",
    "number": "1164540555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3559 PINE STREET",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "48427",
            "telephone_number": "810-376-2835",
            "fax_number": "810-376-9412"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3559 PINE STREET",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "48427",
            "telephone_number": "810-376-2835",
            "fax_number": "810-376-9412"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKERVILLE COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DECKERVILLE COMMUNITY HOSPITAL, INC.",
        "enumeration_date": "2007-03-26",
        "last_updated": "2017-10-05",
        "status": "A",
        "authorized_official_last_name": "GENTNER",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "810-376-2835"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "G61003",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES HEALTH PLAN",
            "identifier": "138358",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deckerville, MI

Sources for this page

Verify at the official NPI Registry.