NPIMap

Organization Active NPI

Beaver Island Rural Health Center

  • Rural Health Clinic/Center
  • Beaver Island, MI
National Provider Identifier
1407828080
Registry record updated Jan 23, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BEAVER ISLAND RURAL HEALTH CENTER
Practice address
37304 Kings Hwy
Beaver Island, MI 49782-9792
Phone
(231) 448-2275
Fax
(231) 448-2348
NPI assigned
Feb 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2013

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

Authorized official

Name
Donna Kubic
Title
Managing Director
Phone
(231) 448-2275

Specialties & licenses 1

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

Addresses

Primary practice location

37304 Kings Hwy
Beaver Island, MI 49782-9792

Mailing address

37304 Kings Hwy
Beaver Island, MI 49782-9792
Phone (231) 448-2275

Other identifiers 1

IdentifierTypeStateIssuer
1407828080MedicaidMI

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050711000160 MI Part B Supplier - Clinic/Group Practice 3971539156 Receives reassigned benefits from 12 practitioners
Practice locations: Beaver Island, MI
O20080423000101 MI Part A Provider - Rural Health Clinic 3971539156 Practice locations: Beaver Island, MI

Rural health clinic certification: CCN 233813

Legal name
BEAVER ISLAND RURAL HEALTH CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 21, 1992
Last certification
Jul 3, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 12, 1996 in MI
Enrollment address
37304 Kings Highway
Beaver Island, MI 49782-5134

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
23D0381877Beaver Island Rural Health Center37304 Kings Highway, Beaver Island, MI 49782Provider-performed microscopyAug 9, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Theresa L Keyes Individual Corporate DirectorBoard Member Jan 10, 2010
John Martin Individual Corporate OfficerVP Jan 10, 2010
Tammy Radionoff Individual W-2 Managing Employee Oct 21, 2019
Beaver Island Rural Health Center Organization, Beaver Island, MI Non-profit 5% Or Greater Direct Ownership Interest Dec 23, 1996 100%
Ann Partridge Individual W-2 Managing Employee Jul 1, 2021

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Practitioners 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358899200000",
    "number": "1407828080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37304 KINGS HWY",
            "city": "BEAVER ISLAND",
            "state": "MI",
            "postal_code": "497829792",
            "telephone_number": "231-448-2275",
            "fax_number": "231-448-2348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "37304 KINGS HWY",
            "city": "BEAVER ISLAND",
            "state": "MI",
            "postal_code": "497829792",
            "telephone_number": "231-448-2275",
            "fax_number": "231-448-2348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAVER ISLAND RURAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-07",
        "last_updated": "2013-01-23",
        "status": "A",
        "authorized_official_last_name": "KUBIC",
        "authorized_official_first_name": "DONNA",
        "authorized_official_title_or_position": "MANAGING DIRECTOR",
        "authorized_official_telephone_number": "231-448-2275"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407828080",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Beaver Island, MI

Sources for this page

Verify at the official NPI Registry.