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Organization Active NPI

Michigan Masonic Home

Doing business as Masonic Pathways

  • Geriatric Medicine (Family Medicine) Physician
  • Alma, MI
National Provider Identifier
1285465633
Registry record updated Aug 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
MICHIGAN MASONIC HOME
Doing business as
Masonic Pathways
Practice address
1200 Wright Ave
Alma, MI 48801-1133
Phone
(989) 466-3864
Fax
(989) 463-8921
NPI assigned
Aug 8, 2024
Last updated
Aug 8, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2024

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

Authorized official

Name
Michelle L Shaw
Title
Health Information Services/Clinic
Phone
(989) 466-3864

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207QG0300X Primary

Addresses

Primary practice location

1200 Wright Ave
Alma, MI 48801-1133

Mailing address

1200 Wright Ave
Alma, MI 48801-1133
Phone (989) 466-3864

Other names 1

  • Masonic Pathways Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20241122000882 MI Part B Supplier - Clinic/Group Practice 8628963311 Receives reassigned benefits from 2 practitioners
Practice locations: Alma, MI

Other NPIs with the same Medicare PAC ID 1

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

National Provider Directory

National Provider Directory
Tax ID family
Michigan Masonic Home4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Masonic PathwaysAlma, MI, CCN 235020 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Direct Ownership Interest (100%)		 Jan 1, 1967
Jan 1, 1967

Owned or controlled facilities with NPI records 2

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

  • Michigan Masonic Home

    dba Masonic Pathways

    • Skilled Nursing Facility
    • Alma, MI
    • NPI 1376545533

    5% Or Greater Direct Ownership Interest, Direct Ownership Interest

    CMS ownership
  • Michigan Masonic Home

    dba Masonic Pathways

    • Skilled Nursing Facility
    • Alma, MI
    • NPI 1619387883

    5% Or Greater Direct Ownership Interest, Direct Ownership Interest

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 3

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": "1723075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723075200000",
    "number": "1285465633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 WRIGHT AVE",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "488011133",
            "telephone_number": "989-466-3864",
            "fax_number": "989-463-8921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 WRIGHT AVE",
            "city": "ALMA",
            "state": "MI",
            "postal_code": "488011133",
            "telephone_number": "989-466-3864",
            "fax_number": "989-463-8921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIGAN MASONIC HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-08",
        "last_updated": "2024-08-08",
        "certification_date": "2024-08-08",
        "status": "A",
        "authorized_official_last_name": "SHAW",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "HEALTH INFORMATION SERVICES/CLINIC",
        "authorized_official_telephone_number": "989-466-3864"
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Masonic Pathways",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Alma, MI

Sources for this page

Verify at the official NPI Registry.