NPIMap

Organization Active NPI

Marlette Regional Hospital

Doing business as Port Sanilac Healthcare

  • Rural Health Clinic/Center
  • Port Sanilac, MI
National Provider Identifier
1306999024
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
MO009325 Issued in MI
Legal business name
MARLETTE REGIONAL HOSPITAL
Doing business as
Port Sanilac Healthcare
Practice address
245 S Ridge St
Port Sanilac, MI 48469-9704
Phone
(810) 376-2835
NPI assigned
Jan 18, 2007
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
Angela McConnachie
Title
Ceo
Phone
(989) 635-4000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X MO009325 MI Primary

Addresses

Primary practice location

245 S Ridge St
Port Sanilac, MI 48469-9704

Mailing address

245 S Ridge St
Port Sanilac, MI 48469-9704
Phone (810) 376-2835

Other identifiers 2

IdentifierTypeStateIssuer
4266244MedicaidMI
080G910100OtherMIBCBSM

Other names 1

  • Port Sanilac Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040709000755 MI Part A Provider - Rural Health Clinic 3971408121 Practice locations: Port Sanilac, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306999024. Details of each certification follow.

Rural health clinic certification: CCN 238582

Legal name
MARLETTE REGIONAL HOSPITAL
Doing business as
PORT SANILAC HEALTHCARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2002
Last certification
May 15, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
245 S Ridge St
Port Sanilac, MI 48469-9704

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Marlette Comm Hosp ER P17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

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 OfficerBoard Member Jan 1, 2024
Faith Ann Fahrner Individual Corporate OfficerBoard Member Jan 1, 2024
Bluewater Healthcare Network Organization, Marlette, MI Corporation Operational/Managerial Control Dec 28, 2012
Patrick D Curtis Individual Corporate OfficerBoard Member Jan 1, 2024
Kimberly Gentner Individual Corporate OfficerCfo Jan 1, 2023
Steven Ellis Individual Corporate Officer Jan 1, 2024
Victoria Meiburg Individual Corporate DirectorBoard Member May 10, 2022
Gail Ann Denton Individual Corporate DirectorBoard Member May 9, 2016
Judy K Brown Individual Corporate OfficerBoard Member Jan 1, 2024
Angela McConnachie Individual Corporate OfficerCeo Jan 1, 2023
W-2 Managing EmployeeCeo Jan 1, 2023
Scott Orr Individual Corporate DirectorBoard Member Nov 2, 2009
Paul Rohling Individual Corporate OfficerBoard Member Jan 1, 2024
Andrew Joseph Daniels Individual Corporate Officer Jan 1, 2024
Erik Tamlyn Individual Corporate OfficerCeo Jan 1, 2024
David Messing Individual Corporate DirectorBoard Member 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.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1306999024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 S RIDGE ST",
            "city": "PORT SANILAC",
            "state": "MI",
            "postal_code": "484699704",
            "telephone_number": "810-376-2835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 S RIDGE ST",
            "city": "PORT SANILAC",
            "state": "MI",
            "postal_code": "484699704",
            "telephone_number": "810-376-2835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLETTE REGIONAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-18",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": "MO009325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4266244",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "080G910100",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Port Sanilac Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Sanilac, MI

Sources for this page

Verify at the official NPI Registry.