NPIMap

Organization Active NPI

Marlette Regional Hospital

  • Family Medicine Physician
  • Marlette, MI
National Provider Identifier
1225495013
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARLETTE REGIONAL HOSPITAL
Practice address
2750 Main St
Marlette, MI 48453-1100
Phone
(989) 635-1840
Fax
(989) 635-4056
NPI assigned
Jan 25, 2016
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Mrs. Angela McConnachie
Title
Ceo
Phone
(989) 635-4000

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X

Addresses

Primary practice location

2750 Main St
Marlette, MI 48453-1100

Mailing address

2770 Main St
PO Box 307
Marlette, MI 48453-1141
Phone (989) 635-4000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031202000143 MI Part B Supplier - Clinic/Group Practice 3971408121 Receives reassigned benefits from 39 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Brown City, MI; Marlette, MI
O20070223000678 MI Part A Provider - Critical Access Hospital 3971408121 Receives reassigned benefits from 164 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marlette, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1225495013. Details of each certification follow.

Hospital certification: CCN 231330

Legal name
MARLETTE REGIONAL HOSPITAL
Doing business as
MARLETTE REGIONAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2005
Last certification
Oct 7, 2005
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
2770 Main St
Marlette, MI 48453-1141
Other Hospital Practice Location

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

Other NPIs on the same Medicare enrollment 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Marlette Regional HospitalCCN 231330 · 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

Locations

2750 Main St
Ste 78
Marlette, MI 48453
Phone (989) 635-1840

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Carol L Starling Individual Corporate DirectorBoard Member Jan 1, 2024
Faith Ann Fahrner Individual Corporate DirectorBoard Member Jan 1, 2024
Bluewater Healthcare Network Organization, Marlette, MI Corporation Operational/Managerial Control Dec 28, 2012
Patrick D Curtis Individual Corporate DirectorBoard Member Jan 1, 2024
Kimberly Gentner Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeAd; Jan 1, 2024
Steven Ellis Individual Corporate DirectorBoard Member Jan 1, 2024
Victoria Meiburg Individual Corporate DirectorBoard Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorVice Chairman May 9, 2016
Judy K Brown Individual Corporate DirectorBoard Member Jan 1, 2024
Angela McConnachie Individual Corporate Director Jan 1, 2023
W-2 Managing Employee Jan 1, 2023
Scott Orr Individual Corporate DirectorBoard Member Nov 2, 2009
Paul Rohling Individual Corporate DirectorBoard Member Jan 1, 2024
Andrew Joseph Daniels Individual Corporate OfficerCeo Jan 1, 2024
W-2 Managing EmployeeAd; Jan 1, 2024
Erik Tamlyn Individual Corporate DirectorBoard Member Jan 1, 2024
David Messing Individual Corporate DirectorChairman Oct 9, 2018

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 30

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 30

Affiliated clinicians 131

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

View all 131

NPI Registry JSON

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

{
    "created_epoch": "1453680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1225495013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2770 MAIN ST",
            "address_2": "PO BOX 307",
            "city": "MARLETTE",
            "state": "MI",
            "postal_code": "484531141",
            "telephone_number": "989-635-4000",
            "fax_number": "989-635-4056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 MAIN ST",
            "city": "MARLETTE",
            "state": "MI",
            "postal_code": "484531100",
            "telephone_number": "989-635-1840",
            "fax_number": "989-635-4056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLETTE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-25",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "MCCONNACHIE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-635-4000",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marlette, MI

Sources for this page

Verify at the official NPI Registry.