Portage Hospital LLC
Organization Active NPI General Acute Care Hospital · Hancock, MI
NPI 1245667229 · NPPES record last updated Jan 15, 2026
Key facts
- NPI
- 1245667229
- Entity type
- Organization (NPI type 2)
- Primary specialty
- General Acute Care Hospital 282N00000X
- Legal business name
- PORTAGE HOSPITAL LLC
- Practice address
- 500 Campus Dr
Hancock, MI 49930-1569 - Phone
- (906) 483-1000
- NPI assigned
- Oct 4, 2013
- Organization subpart
- No
Authorized official
- Name
- Charlotte Lawrence
- Title
- Secretary
- Phone
- (615) 920-7688
Owners & managing parties with NPI records 2
-
William Liston, DO
Other NPIs with the same Medicare PAC ID 4
Member of 1
Related certifications (CCN) 1
Facilities with the same owner 193
Practitioners 57
-
George Alan Krzymowski, M.D.
-
Jeffrey Allen Conklin, M.D.
-
Andrew Lawrence Atkinson, M.D.
-
Sara Barnett, CRNA
-
David James Bradley, M.D.
-
Brandon J Churchman, PA-C, DDS
-
Timothy B Cotts, MD
-
Mark David Cowan, MD
-
Jerry Russell Hill, CRNA
-
Charlene Howland, CRNA
-
Kathryn E Kass, PA
-
Kirk R Klemme, MD
-
Amy Martyanov, M.D.
-
Tracey Lyn McMullen, CRNA
-
Joni A Meyers, CRNA
-
Megan Mukavetz, P.A.
-
Dawn Nulf, MD
-
John Michael Pap, MD
Affiliated clinicians 161
-
Khurshaid Alam, MD
-
Zainab Almahrous, MD
-
Todd W Anderson, DO
-
Tobiloba Bamigboje, M.D.
-
Jenny M Bausano, FNP
-
Nicole L Blaauw, PA-C
-
Austin Bramwell, MD
-
Melissa A Broeders, P.A.-C
-
Amy Sue Burri, FNP
-
Jessica Caulkins, FNP-C
-
Toni M Clisch, NP-C
-
Jeffrey Allen Conklin, M.D.
-
Jasmin J David, CRNA
-
Alycia Davidson, FNP-C
-
Devyn Dempsey, DO
-
Marilynn S. Dewald, M.D.
-
Karen Marie Deyoung, D.O.
-
Ericka Marie Distefano, FNP, ACUPUNCTURIST
Medicare Care Compare: Hospital
- Listed as
- Up Health System Portage
- Overall star rating
- ★★★★★ 5 of 5
- Type
- Acute Care Hospitals
- Ownership
- Voluntary non-profit - Other
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Hospital certification: CCN 230108
- Legal name
- PORTAGE HOSPITAL LLC
- Doing business as
- UP HEALTH SYSTEM PORTAGE
- Certification status
- Active
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Jul 8, 1988
- Last certification
- Jul 8, 1988
- Beds
- 36
- Ownership / control type
- Other
- Most recent change of ownership
- Dec 1, 2013 (1 total)
- Organization structure
- LLC · Proprietary
- Enrollment address
- 500 Campus Dr
Hancock, MI 49930-1452 - Hospital subgroups
- Acute care
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Lifepoint Holdings 2 LLC |
5% Or Greater Indirect Ownership Interest | Apr 17, 2013 | 80% |
| Ryan K. Heinonen |
W-2 Managing Employee |
Jan 10, 2022 | |
| Portage Health Foundation |
5% Or Greater Indirect Ownership Interest | Dec 1, 2013 | 20% |
| Portage Holding Company LLC |
5% Or Greater Direct Ownership Interest | Apr 17, 2013 | 100% |
| Bruce a. Rukkila |
Other |
Aug 5, 2019 | |
| Kevin Store |
Other |
Nov 1, 2016 | |
| William W Liston |
Other |
Nov 30, 2013 | |
| DSB Acquisition LLC |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 80% |
| Lifepoint Hospitals Holdings LLC |
5% Or Greater Indirect Ownership Interest | Apr 17, 2013 | 80% |
| Elmer B Polite |
Corporate Officer |
Dec 14, 2020 | |
| Other |
Dec 14, 2020 | ||
| Historic Lifepoint Hospitals, LLC |
5% Or Greater Indirect Ownership Interest | Apr 17, 2013 | 80% |
| Timothy John Labonte |
Other |
May 7, 2020 | |
| Lifepoint Health Inc |
5% Or Greater Indirect Ownership Interest | Nov 16, 2018 | 80% |
| Marcus B Poppell |
Corporate Officer |
Nov 16, 2018 | |
| Other |
Dec 1, 2013 | ||
| Kristine Weidner |
Other |
Jun 1, 2017 | |
| Charlotte E Lawrence |
Corporate Officer |
Feb 10, 2022 | |
| HSC Manager LLC |
Operational/Managerial Control | Dec 1, 2013 | |
| Teresa Williams |
Other |
May 31, 2024 | |
| Elliott Brown |
Corporate Officer |
Apr 2, 2026 | |
| Jonathan C Wall |
Corporate Director |
Sep 1, 2025 | |
| Phillip Sensing |
Corporate Officer |
May 4, 2026 | |
| Christopher J Monte |
Corporate Officer |
Apr 17, 2013 | |
| Legacy Lifepoint Health LLC |
5% Or Greater Indirect Ownership Interest | Apr 17, 2013 | 80% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140123000490 | MI | Part a Provider - Hospital | 1951538883 | Practice locations: Lake Linden, MI; Houghton, MI; Hancock, MI; Calumet, MI |
| O20140224000087 | MI | Part B Supplier - Clinic/Group Practice | 1951538883 |
Receives reassigned benefits from 44 practitioners Practice locations: Hancock, MI |
National Provider Directory
Locations
894 Campus Dr
Ste B
Hancock, MI 49930
Phone (906) 483-1128
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Acute Care Hospital | 282N00000X | Yes |
Addresses
Primary practice location
500 Campus Dr
Hancock, MI 49930-1569
Mailing address
330 Seven Springs Way
Brentwood, TN 37027-4536
Phone (615) 920-7000
Other names
- UP Health System Portage
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | phs@direct.uphsportage.net |
Other providers in Hancock, MI
- Portage Hearing Services
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
- Portage Hospital LLC
All providers in Hancock, MI · General Acute Care Hospital in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 15, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.