NPIMap

Organization Active NPI

Harbor Beach Community Hospital Inc

Doing business as Port Hope Medical Clinic

  • Rural Health Clinic/Center
  • Port Hope, MI
National Provider Identifier
1164908703
Registry record updated Feb 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HARBOR BEACH COMMUNITY HOSPITAL INC
Doing business as
Port Hope Medical Clinic
Scheurer Primary Care - Port Hope
Practice address
4255 N Lakeshore Rd
Port Hope, MI 48468
Phone
(989) 428-1000
Fax
(989) 428-1001
NPI assigned
Jul 17, 2018
Last updated
Feb 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2026

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

Authorized official

Name
Jill Wehner
Title
President
Phone
(989) 479-5013

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Nurse Practitioner 363LF0000X 4704266641 MI

Addresses

Primary practice location

4255 N Lakeshore Rd
Port Hope, MI 48468

Mailing address

4255 N Lakeshore Rd
Port Hope, MI 48468-9396
Phone (989) 428-1000

Other names 2

  • Port Hope Medical Clinic Doing business as
  • Scheurer Primary Care - Port Hope Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040908001458 MI Part B Supplier - Clinic/Group Practice 7214903483 Receives reassigned benefits from 26 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Harbor Beach, MI; Port Hope, MI
O20180808001766 MI Part A Provider - Rural Health Clinic 7214903483 Practice locations: Port Hope, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164908703. Details of each certification follow.

Rural health clinic certification: CCN 238715

Legal name
HARBOR BEACH COMMUNITY HOSPITAL INC
Doing business as
PORT HOPE MEDICAL CLINIC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 2, 2019
Last certification
May 2, 2019
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Aug 15, 1957 in MI
Enrollment address
4255 N Lakeshore Rd
Port Hope, MI 48468-9396
Related CCNs
231313

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 9

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1040303Port Hope Medical Clinic4255 N Lakeshore Road, Port Hope, MI 48468Certificate of waiverMay 4, 2027

National Provider Directory

National Provider Directory
Tax ID family
Harbor Beach Comm Hosp 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

4255 N Lakeshore Rd
Port Hope, MI 48468
Phone (989) 428-1000

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Elias S Kabban Individual Corporate DirectorBoard Trustee Jan 1, 2008
Jennifer Siemen Individual W-2 Managing EmployeeClinic Coordinator Aug 8, 2018
Patrick McCollough Individual Corporate DirectorBoard Trustee Apr 27, 2011
Janet Sloan Individual Corporate DirectorBoard Trustee Jul 23, 2013
Scott Rayl Individual Corporate DirectorBoard Trustee Apr 28, 2010
Nicklaus M Bradley Individual W-2 Managing EmployeeEmployee Aug 1, 2019
Misty Johnston Individual W-2 Managing EmployeeOffice Manager Jan 1, 2024
Jill Wehner Individual Corporate OfficerVP, Coo Aug 8, 2018
W-2 Managing EmployeeVP, Coo Aug 8, 2018
David Hunter Individual Corporate DirectorBoard Trustee Jan 1, 2008
Gregory Woodke Individual Corporate DirectorBoard Trustee Jun 1, 2015

Owners & managing parties with NPI records 1

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

NPI Registry JSON

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

{
    "created_epoch": "1531785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770681600000",
    "number": "1164908703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4255 N LAKESHORE RD",
            "city": "PORT HOPE",
            "state": "MI",
            "postal_code": "484689396",
            "telephone_number": "989-428-1000",
            "fax_number": "989-428-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4255 N LAKESHORE RD",
            "city": "PORT HOPE",
            "state": "MI",
            "postal_code": "48468",
            "telephone_number": "989-428-1000",
            "fax_number": "989-428-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR BEACH COMMUNITY HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-07-17",
        "last_updated": "2026-02-10",
        "certification_date": "2026-02-10",
        "status": "A",
        "authorized_official_last_name": "WEHNER",
        "authorized_official_first_name": "JILL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-479-5013"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704266641",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Hope Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Port Hope Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Scheurer Primary Care - Port Hope",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Hope, MI

Sources for this page

Verify at the official NPI Registry.