Individual provider Active NPI

Rachel Distelrath, FNP-BC

  • Family Nurse Practitioner
  • Port Huron, MI
National Provider Identifier
1184440158
Registry record updated Jan 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704292139 Issued in MI
Practice address
1210 10TH Ave
Port Huron, MI 48060-3406
Phone
(810) 662-3505
NPI assigned
Nov 25, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704292139 MI Primary

Addresses

Primary practice location

1210 10TH Ave
Port Huron, MI 48060-3406

Mailing address

1210 10TH Ave
Port Huron, MI 48060-3406
Phone (810) 662-3505

Other names 1

  • Rachel McGregor Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250228003336 MI Practitioner - Nurse Practitioner 9739600149 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Water Internal Medicine PCGroup PAC ID 3577994490, 4 clinicians

Practice addresses (Care Compare)

1210 10TH Ave
Port Huron, MI 48060-3406
Phone (810) 662-3505

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704292139MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Water Internal Medicine, PC CurrentSince Jan 1, 2025 Accepting new patients

Locations

1210 10th Ave
Port Huron, MI 48060
Phone (810) 662-3505

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BIGACD

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1732492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1769040000000",
    "number": "1184440158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603406",
            "telephone_number": "810-662-3505",
            "fax_number": "810-662-3479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 10TH AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603406",
            "telephone_number": "810-662-3505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISTELRATH",
        "first_name": "RACHEL",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-11-25",
        "last_updated": "2026-01-22",
        "certification_date": "2026-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704292139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "RACHEL",
            "last_name": "MCGREGOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.