NPIMap

Organization Active NPI

Midmichigan Health Services

Doing business as MidMichigan Medical Offices-West Branch

  • Federally Qualified Health Center (FQHC)
  • West Branch, MI
National Provider Identifier
1255109484
Registry record updated Dec 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MIDMICHIGAN HEALTH SERVICES
Doing business as
MidMichigan Medical Offices-West Branch
Practice address
565 Progress St Ste D
West Branch, MI 48661-9382
Phone
(989) 422-5122
Fax
(989) 422-4378
NPI assigned
Dec 18, 2023
Last updated
Dec 18, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2023

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

Authorized official

Name
Melissa J Dunkle
Title
Ceo
Phone
(989) 422-5122

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

565 Progress St Ste D
West Branch, MI 48661-9382

Mailing address

9249 W. Lake City Rd.
Houghton Lake, MI 48629-9602
Phone (989) 422-5122

Other names 1

  • MidMichigan Medical Offices-West Branch Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240305003084 MI Part A Provider - Federally Qualified Health Center (FQHC) 7911800495 Practice locations: West Branch, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255109484. Details of each certification follow.

Federally qualified health center certification: CCN C71016

Legal name
MIDMICHIGAN HEALTH SERVICES
Doing business as
MIDMICHIGAN MEDICAL OFFICES-WEST BRANCH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Feb 19, 2024
Last certification
Feb 19, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
565 Progress St
Ste D
West Branch, MI 48661-8601

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2294997Midmichigan Community Health Services Sud-West565 Progress Street Suite D, West Branch, MI 48661Certificate of waiverDec 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Peter a Kuhl MD5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Dawn M Lacasse Individual Corporate DirectorBoard Member Jan 1, 2005 100%
Deborah S Vanwert Individual Corporate DirectorBoard Member Jan 1, 2010 100%
Raymond H Stover Individual Corporate DirectorBoard Member Jan 1, 2012 100%
Frederick F Roemer Individual Corporate DirectorBoard Member Jan 1, 2005 100%
Edward F Stern Individual Corporate DirectorBoard Member Jan 1, 2023 100%
Shannon E Phelps Individual Corporate DirectorBoard Member Jan 1, 2012 100%
Bryan R Cross Individual Corporate DirectorBoard Member Jan 1, 2023 100%
William Collin Individual Corporate OfficerCfo Dec 1, 2016 100%
Jeffrey B Fossitt Individual Corporate DirectorBoard Member Jan 1, 1990 100%
Thomas J Moreau Individual Corporate DirectorBoard Member Jan 1, 1999 100%
Robert Patrick McMorrow Individual Corporate OfficerCmo Sep 1, 2022 100%
Lenard S Govitz Individual Corporate DirectorBoard Member Jan 1, 2020 100%
Melissa J Dunkle Individual Corporate OfficerCeo Sep 1, 2023 100%
W-2 Managing EmployeeCeo Sep 1, 2023 100%
Gregory H Rogers Individual Corporate DirectorBoard Member Jan 1, 2016 100%
Jennifer Shamel Individual Corporate OfficerCoo Dec 1, 2020 100%
James C Bischoff Individual Corporate DirectorBoard Member Jan 1, 1994 100%
Joseph Passalacqua Individual Corporate DirectorBoard Member Jan 1, 2020 100%

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Midmichigan Medical Offices BeavertonBeaverton, MI, CCN 231987 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Nov 1, 2012
Coleman School Based Health CenterColeman, MI, CCN C71027 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Apr 9, 2024
Beaverton School Wellness CenterBeaverton, MI, CCN C71033 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Aug 27, 2024

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1702857600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702857600000",
    "number": "1255109484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9249 W. LAKE CITY RD.",
            "city": "HOUGHTON LAKE",
            "state": "MI",
            "postal_code": "486299602",
            "telephone_number": "989-422-5122",
            "fax_number": "989-422-4378"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "565 PROGRESS ST STE D",
            "city": "WEST BRANCH",
            "state": "MI",
            "postal_code": "486619382",
            "telephone_number": "989-422-5122",
            "fax_number": "989-422-4378"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDMICHIGAN HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-18",
        "last_updated": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "DUNKLE",
        "authorized_official_first_name": "MELISSA",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-422-5122"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MidMichigan Medical Offices-West Branch",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Branch, MI

Sources for this page

Verify at the official NPI Registry.