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Organization Active NPI

McLaren Port Huron

Doing business as Port Huron Hospital Physician GRP

  • Psychiatry Physician
  • Port Huron, MI
National Provider Identifier
1386888170
Registry record updated Oct 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
JM013191 Issued in MI
Legal business name
MCLAREN PORT HURON
Doing business as
Port Huron Hospital Physician GRP
Practice address
1209 Richardson St
Port Huron, MI 48060-3548
Phone
(810) 984-5156
NPI assigned
Apr 24, 2009
Last updated
Oct 13, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2026

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

Authorized official

Name
Kyle Christopher Albert Vining
Title
VP/Cfo
Phone
(810) 989-3700

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X MN084311 MI
Clinical Social Worker 1041C0700X AG643729 MI
Internal Medicine Physician 207R00000X MS040821 MI
Psychiatry Physician 2084P0800X JM013191 MI Primary

Addresses

Primary practice location

1209 Richardson St
Port Huron, MI 48060-3548

Mailing address

1221 Pine Grove Ave
Port Huron, MI 48060-3511
Phone (810) 984-5156

Other names 1

  • PORT HURON HOSPITAL PHYSICIAN GRP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000779 MI Part B Supplier - Clinic/Group Practice 9931018702 Receives reassigned benefits from 90 practitioners
4 other NPIs on this enrollment
Practice locations: Saint Clair, MI; Port Huron, MI; Fort Gratiot, MI; East China, MI; Deckerville, MI

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
McLaren Port Huron2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

1209 Richardson St
Port Huron, MI 48060
Phone (810) 984-5156

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
Marwood Nursing & RehabPort Huron, MI, CCN 235369 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Direct Ownership Interest (100%)		 Jan 1, 1987
Jan 1, 1987

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 100

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 100

NPI Registry JSON

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

{
    "created_epoch": "1240531200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791849600000",
    "number": "1386888170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 PINE GROVE AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603511",
            "telephone_number": "810-984-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 RICHARDSON ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603548",
            "telephone_number": "810-984-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN PORT HURON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-24",
        "last_updated": "2026-10-13",
        "certification_date": "2026-10-13",
        "status": "A",
        "authorized_official_last_name": "VINING",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "CHRISTOPHER ALBERT",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "810-989-3700"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MI",
            "license": "MN084311",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "AG643729",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "MS040821",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "JM013191",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT HURON HOSPITAL PHYSICIAN GRP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PORT HURON HOSPITAL PHYSICIAN GRP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.