NPIMap

Organization Active NPI

Northern Michigan Substance Abuse Services, Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Gaylord, MI
National Provider Identifier
1164641676
Registry record updated Oct 27, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
License
690031 Issued in MI
Legal business name
NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES, INC.
Practice address
2136 W M 32
Gaylord, MI 49735-9282
Phone
(989) 732-1791
Fax
(989) 732-7052
NPI assigned
Apr 24, 2007
Last updated
Oct 27, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2014

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

Authorized official

Name
Sue Winter
Title
Executive Director
Phone
(989) 732-1791

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X 690031 MI Primary
Community/Behavioral Health Agency 251S00000X SA0690031 MI

Addresses

Primary practice location

2136 W M 32
Gaylord, MI 49735-9282

Mailing address

2136 W M 32
Gaylord, MI 49735-9282
Phone (989) 732-1791

Other identifiers 1

IdentifierTypeStateIssuer
174458207MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments
Opioid treatment program
Medicare-enrolled since Jan 1, 2020

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150819007821 MI Part B Supplier - Clinic/Group Practice 3971818998 Receives reassigned benefits from 4 practitioners
Practice locations: Gaylord, MI
O20191221000229 MI Part B Supplier - Opioid Treatment Program (Otp) 3971818998 Practice locations: Gaylord, MI

National Provider Directory

National Provider Directory

Locations

2136 W M 32
Gaylord, MI 49735
Phone (989) 732-1791

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1164641676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2136 W M 32",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359282",
            "telephone_number": "989-732-1791",
            "fax_number": "989-732-7052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2136 W M 32",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497359282",
            "telephone_number": "989-732-1791",
            "fax_number": "989-732-7052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN SUBSTANCE ABUSE SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "WINTER",
        "authorized_official_first_name": "SUE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "989-732-1791"
    },
    "taxonomies": [
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": "MI",
            "license": "690031",
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "MI",
            "license": "SA0690031",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "174458207",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.