NPIMap

Organization Active NPI

Mycare Health Center

  • Federally Qualified Health Center (FQHC)
  • Mount Clemens, MI
National Provider Identifier
1265749683
Registry record updated Jul 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
MYCARE HEALTH CENTER
Practice address
18 Market Street
Suite C
Mount Clemens, MI 48043
Phone
(586) 783-2222
Fax
(586) 783-6944
NPI assigned
Sep 7, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2020

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

Authorized official

Name
Karen Wood
Title
Ceo
Phone
(586) 619-9986

Specialties & licenses 2

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

Addresses

Primary practice location

18 Market Street
Suite C
Mount Clemens, MI 48043

Mailing address

6800 E 10 Mile Rd
Center Line, MI 48015-1167
Phone (586) 619-9986

Other identifiers 4

IdentifierTypeStateIssuer
080E031630OtherMIBCBS GROUP
1265749683MedicaidMI
080E031630OtherMIBCN GROUP
0E03765OtherMIBC NP GROUP PIN

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110329000826 MI Part B Supplier - Clinic/Group Practice 6406039403 Receives reassigned benefits from 27 practitioners
4 other NPIs on this enrollment
Practice locations: Clinton Township, MI; Centerline, MI; Mt Clemens, MI; Clinton TWP, MI
O20141231000034 MI Part A Provider - Federally Qualified Health Center (FQHC) 6406039403 Practice locations: Mount Clemens, MI

Federally qualified health center certification: CCN 231044

Legal name
MYCARE HEALTH CENTER
Doing business as
MYCARE HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 19, 2015
Last certification
Jan 19, 2015
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Incorporated
Jan 4, 2010 in MI
Enrollment address
18 Market St
Ste C
Mount Clemens, MI 48043-7403

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Karen L Wood Individual Corporate OfficerCeo Jan 12, 2017 100%
W-2 Managing EmployeeCeo Jan 12, 2017 100%
Operational/Managerial Control Jan 12, 2017
Jamie Wetherall Individual Corporate OfficerCfo Apr 27, 2016 100%
W-2 Managing EmployeeCfo Oct 10, 2016 100%

National Provider Directory

National Provider Directory

Locations

6800 E 10 Mile Rd
Center Line, MI 48015

Interoperability endpoints

  • Direct secure messaging: christineallor@mchc.allscriptsdirect.net
  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10018231
  • Direct secure messaging: adriannecouwlier@mchc.allscriptsdirect.net
  • Direct secure messaging: anngillett-elrington@mchc.allscriptsdirect.net
  • Direct secure messaging: tessaadams@mchc.allscriptsdirect.net
  • Direct secure messaging: koriagius@mchc.allscriptsdirect.net
  • Direct secure messaging: donyellemoore-baldwin@mchc.allscriptsdirect.net
  • Direct secure messaging: vasudevamandava@mchc.allscriptsdirect.net
  • Direct secure messaging: jennifergoodin@mchc.allscriptsdirect.net
  • Direct secure messaging: scottmccormick@mchc.allscriptsdirect.net
  • Direct secure messaging: hemlattadesai@mchc.allscriptsdirect.net
  • Direct secure messaging: nicolehentschel@mchc.allscriptsdirect.net
  • Direct secure messaging: lawrencebrown@mchc.allscriptsdirect.net
  • Direct secure messaging: davidmacon@mchc.allscriptsdirect.net

Other NPIs on the same Medicare enrollment 4

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

Other NPIs with the same Medicare PAC ID 3

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

Practitioners 30

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

View all 30

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
23D2014349Mycare Health Center18 Market Street Suite C, Mount Clemens, MI 48043Certificate of waiverOct 5, 2026

NPI Registry JSON

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

{
    "created_epoch": "1283817600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1594080000000",
    "number": "1265749683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6800 E 10 MILE RD",
            "city": "CENTER LINE",
            "state": "MI",
            "postal_code": "480151167",
            "telephone_number": "586-619-9986",
            "fax_number": "586-806-5085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 MARKET STREET",
            "address_2": "SUITE C",
            "city": "MOUNT CLEMENS",
            "state": "MI",
            "postal_code": "48043",
            "telephone_number": "586-783-2222",
            "fax_number": "586-783-6944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYCARE HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-07",
        "last_updated": "2020-07-07",
        "certification_date": "2020-07-07",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-619-9986"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "080E031630",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1265749683",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN GROUP",
            "identifier": "080E031630",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC NP GROUP PIN",
            "identifier": "0E03765",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Clemens, MI

Sources for this page

Verify at the official NPI Registry.