Individual provider Active NPI

Carl Russell Hubble, PA-C

  • Medical Physician Assistant
  • Midland, MI
National Provider Identifier
1194007674
Registry record updated Nov 12, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
Practice address
4000 Wellness Dr
Midland, MI 48670-0001
Phone
(989) 839-1644
Fax
(989) 839-3029
NPI assigned
Sep 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X Primary

Addresses

Primary practice location

4000 Wellness Dr
Midland, MI 48670-0001

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (989) 839-1644

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
I20120105000276 MI Practitioner - Physician Assistant 4284800798 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mymichigan Medical GroupGroup PAC ID 4981501939, 174 clinicians

Practice addresses (Care Compare)

4000 Wellness Dr
Midland, MI 48670-2000

609 Quarter St
Gladwin, MI 48624-1941
Phone (989) 246-6490

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Mymichigan Medical Center Sault CurrentSince Aug 1, 2025 Accepting new patients
Mymichigan Medical Group CurrentSince Dec 16, 2011 Accepting new patients
Mymichigan Medical Center Alpena CurrentSince Dec 16, 2011 Accepting new patients
Mymichigan Medical Center Sault CurrentSince Aug 1, 2025 Accepting new patients
Mymichigan Medical Center Sault Past Accepting new patients

Locations

609 Quarter St
Gladwin, MI 48624
Phone (989) 246-6371

815 N Clare Ave
Harrison, MI 48625
Phone (989) 539-4096

4000 Wellness Dr
Midland, MI 48670
Phone (844) 832-1956

500 Osborn Blvd
Sault South Marie, MI 49783
Phone (906) 635-4350

2463 S M 30
West Branch, MI 48661
Phone (517) 345-3660

Organizations & group practices 7

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 4

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": "1315785600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573516800000",
    "number": "1194007674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "989-839-1644",
            "fax_number": "989-839-1376"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486700001",
            "telephone_number": "989-839-1644",
            "fax_number": "989-839-3029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUBBLE",
        "first_name": "CARL",
        "middle_name": "RUSSELL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-09-12",
        "last_updated": "2019-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Midland, MI

Sources for this page

Verify at the official NPI Registry.