NPIMap

Organization Active NPI

Kalkaska Memorial Health Center

  • Family Medicine Physician
  • Kalkaska, MI
National Provider Identifier
1376799650
Registry record updated Nov 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KALKASKA MEMORIAL HEALTH CENTER
Practice address
419 S Coral St
Kalkaska, MI 49646-2503
Phone
(231) 258-7500
Fax
(231) 258-7527
NPI assigned
Aug 18, 2008
Last updated
Nov 7, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 7, 2023

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

Authorized official

Name
Mr. Andrew Richard Raymond, FACHE
Title
Ceo
Phone
(231) 258-3651

Specialties & licenses 14

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
Family Nurse Practitioner 363LF0000X
Clinical Psychologist 103TC0700X
Family Medicine Physician 207Q00000X Primary
Gastroenterology Physician 207RG0100X
Pulmonary Disease Physician 207RP1001X
Obstetrics & Gynecology Physician 207V00000X
Orthopaedic Trauma Physician 207XX0801X
Otolaryngology Physician 207Y00000X
Pediatrics Physician 208000000X
Pain Medicine (Physical Medicine & Rehabilitation) Physician 2081P2900X
Surgery Physician 208600000X
Foot & Ankle Surgery Podiatrist 213ES0103X

Addresses

Primary practice location

419 S Coral St
Kalkaska, MI 49646-2503

Mailing address

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040813000668 MI Part B Supplier - Clinic/Group Practice 3577536002 Receives reassigned benefits from 111 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kalkaska, MI; Mancelona, MI

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: aboyce@direct.mhc.net
  • Direct secure messaging: acole4@direct.mhc.net
  • Direct secure messaging: ahockin@direct.mhc.net
  • Direct secure messaging: along2@direct.mhc.net
  • Direct secure messaging: bdaman@direct.mhc.net
  • Direct secure messaging: bheeringa@direct.mhc.net
  • Direct secure messaging: csheerin@direct.mhc.net
  • Direct secure messaging: csmith4@direct.mhc.net
  • Direct secure messaging: dauer2@direct.mhc.net
  • Direct secure messaging: dgentry@direct.mhc.net
  • Direct secure messaging: dspencer2@direct.mhc.net
  • Direct secure messaging: heves2@direct.mhc.net
  • Direct secure messaging: jholmes@direct.mhc.net
  • Direct secure messaging: jmilliken1@direct.mhc.net
  • Direct secure messaging: jpolanic@direct.mhc.net
  • Direct secure messaging: jstych@direct.mhc.net
  • Direct secure messaging: llemonnier@direct.mhc.net
  • Direct secure messaging: mcupp2@direct.mhc.net
  • Direct secure messaging: mdelaney@direct.mhc.net
  • Direct secure messaging: mfischer2@direct.mhc.net

Practitioners & affiliated clinicians

Practitioners 44

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.

View all 44

NPI Registry JSON

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

{
    "created_epoch": "1219017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699315200000",
    "number": "1376799650",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503",
            "telephone_number": "231-258-7500",
            "fax_number": "231-258-7527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503",
            "telephone_number": "231-258-7500",
            "fax_number": "231-258-7527"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALKASKA MEMORIAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-18",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "231-258-3651",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "FACHE"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207XX0801X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Orthopaedic Trauma",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalkaska, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.