NPIMap

Organization Active NPI

Covenant Pathology Associates, PC

  • Wound Care Registered Nurse
  • Saginaw, MI
National Provider Identifier
1194476804
Registry record updated Jan 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Wound Care Registered NurseTaxonomy code 163WW0000X
Legal business name
COVENANT PATHOLOGY ASSOCIATES, PC
Practice address
4707 McLeod Dr E
Saginaw, MI 48604-2853
Phone
(989) 341-5078
NPI assigned
Jan 13, 2022
Organization subpart
Yes
Parent organization
COVENANT PATHOLOGY ASSOCIATES, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 13, 2022

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

Authorized official

Name
David L. Stockman, MD
Title
President
Phone
(989) 459-2300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Wound Care Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WW0000X Primary

Addresses

Primary practice location

4707 McLeod Dr E
Saginaw, MI 48604-2853

Mailing address

3925 Fortune Blvd
Saginaw, MI 48603-2287
Phone (989) 459-2300

Other practice location 1

3925 Fortune Blvd
Saginaw, MI 48603-2287
Phone (989) 459-2300

Other names 1

  • MI Health Clinic Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040405000837 MI Part B Supplier - Clinic/Group Practice 5991798183 Receives reassigned benefits from 7 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Bad Axe, MI; Cass City, MI; Saginaw, MI

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Michigan Health Clinics PC5 organizations share this tax ID, including this one
Part of
Michigan Health Clinics PC

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1642032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1642032000000",
    "number": "1194476804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3925 FORTUNE BLVD",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486032287",
            "telephone_number": "989-459-2300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4707 MCLEOD DR E",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486042853",
            "telephone_number": "989-341-5078"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3925 Fortune Blvd",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486032287",
            "country_code": "US",
            "telephone_number": "989-459-2300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COVENANT PATHOLOGY ASSOCIATES, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT PATHOLOGY ASSOCIATES, PC",
        "enumeration_date": "2022-01-13",
        "last_updated": "2022-01-13",
        "certification_date": "2022-01-13",
        "status": "A",
        "authorized_official_last_name": "STOCKMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "989-459-2300",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "163WW0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Wound Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MI Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2022; 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.