NPIMap

Organization Active NPI

Deckerville Community Hospital, Inc.

  • Family Medicine Physician
  • Deckerville, MI
National Provider Identifier
1164818977
Registry record updated Jun 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DECKERVILLE COMMUNITY HOSPITAL, INC.
Practice address
3532 Main St
Deckerville, MI 48427-9615
Phone
(810) 376-3100
Fax
(810) 376-8311
NPI assigned
Apr 8, 2015
Last updated
Jun 8, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
DECKERVILLE COMMUNITY HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 8, 2023

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

3532 Main St
Deckerville, MI 48427-9615

Mailing address

3532 Main St
Deckerville, MI 48427-9615
Phone (810) 376-3100

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080321000183 MI Part A Provider - Critical Access Hospital 2163508821 Receives reassigned benefits from 163 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Port Sanilac, MI; Deckerville, MI
O20110523000767 MI Part B Supplier - Hospital Department(S) 2163508821 Receives reassigned benefits from 87 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Deckerville, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164818977. Details of each certification follow.

Hospital certification: CCN 231311

Legal name
DECKERVILLE COMMUNITY HOSPITAL INC
Doing business as
DECKERVILLE COMMUNITY HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 9, 2000
Last certification
Dec 17, 2020
Beds
15
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Sep 4, 1968 in MI
Enrollment address
3559 Pine St
Deckerville, MI 48427-7703
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Deckerville Community HospitalCCN 231311 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Deckerville Hospital Inc

Locations

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

Ownership & related parties

All disclosed owners & managing parties 12

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 1, 2016
W-2 Managing EmployeeDirector of Finance Apr 1, 2015
Victoria Meiburg Individual Corporate DirectorBoard of Directors Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorBoard of Directors, Member Sep 10, 2018
Angela McConnachie Individual Corporate OfficerCeo Jan 1, 2023
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 Sep 1, 2018
Curtis Landrith Individual Corporate DirectorBoard of Directors, Member Sep 8, 2020
Sue Cook Individual Corporate DirectorBoard of Directors Member May 11, 2021
David Messing Individual Corporate DirectorBoard of Directors, Member Jan 1, 2015
Irene Cole Individual Corporate DirectorBoard of Directors, Member Jan 1, 2017

Practitioners & affiliated clinicians

Practitioners 105

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 105

Affiliated clinicians 62

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 62

NPI Registry JSON

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

{
    "created_epoch": "1428451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686182400000",
    "number": "1164818977",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3532 MAIN ST",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279615",
            "telephone_number": "810-376-3100",
            "fax_number": "810-376-8311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3532 MAIN ST",
            "city": "DECKERVILLE",
            "state": "MI",
            "postal_code": "484279615",
            "telephone_number": "810-376-3100",
            "fax_number": "810-376-8311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DECKERVILLE COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DECKERVILLE COMMUNITY HOSPITAL, INC.",
        "enumeration_date": "2015-04-08",
        "last_updated": "2023-06-08",
        "certification_date": "2023-06-08",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Deckerville, MI

Sources for this page

Verify at the official NPI Registry.