Active NPI
McLaren Thumb Region
- Rural Health Clinic/Center
- Bad Axe, MI
National Provider Identifier
1437405172
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rural Health Clinic/Center
- License
- 1060000058
- Legal business name
- MCLAREN THUMB REGION
- Practice address
- 1040 S Van Dyke Rd
Bad Axe, MI 48413-9602 - Phone
- (989) 269-9521
- Fax
- (989) 269-5260
- NPI assigned
- Jul 31, 2012
- Organization subpart
- Yes
- Parent organization
- MCLAREN THUMB REGION
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kenneth Baranski
- Title
- VP/Cfo
- Phone
- (989) 269-1510
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | 1060000058 | MI | Primary |
Addresses
Primary practice location
1040 S Van Dyke Rd
Bad Axe, MI 48413-9602
Mailing address
1100 S Van Dyke Rd
Bad Axe, MI 48413-9615
Phone (989) 269-9521
Other names 1
- THUMB CONVENIENT CARE CLINIC
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200803002466 | MI | Part A Provider - Rural Health Clinic | 6800709221 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Port Austin, MI |
Rural health clinic certification: CCN 238753
- Legal name
- MCLAREN THUMB REGION
- Doing business as
- PORT AUSTIN PRIMARY CARE CLINIC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Jun 4, 2021
- Last certification
- Jun 4, 2021
- Ownership / control type
- 2B
- Organization structure
- Corporation
- Enrollment address
- 24 E Spring St
Port Austin, MI 48467-6736 - Related CCNs
- 231340
Related certifications (CCN) 1
Facilities connected through Provider of Services related, parent or unit certification numbers.
Other NPIs on the same Medicare enrollment 1
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Part of
- McLaren Thumb Region
Ownership & related parties
All disclosed owners & managing parties 10
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Michael Murawski | Corporate Director | May 1, 2023 | |
| Donald J Clark | Corporate Director | Nov 17, 1980 | |
| Kenneth E Baranski | Corporate Officer | Jan 14, 2025 | |
| W-2 Managing Employee | Jan 14, 2025 | ||
| Operational/Managerial Control | Jan 14, 2025 | ||
| John M Hunt | Corporate Director | Nov 26, 2012 | |
| Chad Grant | Corporate Director | Aug 7, 2021 | |
| Doug P Brining | Corporate Director | Oct 29, 2001 | |
| Connie Koutouzos | Corporate Officer | Nov 15, 2021 | |
| W-2 Managing Employee | Nov 15, 2021 | ||
| Operational/Managerial Control | Nov 15, 2021 | ||
| Philip a Incarnati | Other | May 11, 2018 | |
| McLaren Health Care Corporation | 5% Or Greater Direct Ownership Interest | May 11, 2018 | 100% |
| Mary C Rapson | Corporate Director | Mar 5, 2018 |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343692800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1731542400000",
"number": "1437405172",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 S VAN DYKE RD",
"city": "BAD AXE",
"state": "MI",
"postal_code": "484139615",
"telephone_number": "989-269-9521",
"fax_number": "989-269-5260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1040 S VAN DYKE RD",
"city": "BAD AXE",
"state": "MI",
"postal_code": "484139602",
"telephone_number": "989-269-9521",
"fax_number": "989-269-5260"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MCLAREN THUMB REGION",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MCLAREN THUMB REGION",
"enumeration_date": "2012-07-31",
"last_updated": "2024-11-14",
"certification_date": "2024-11-14",
"status": "A",
"authorized_official_last_name": "BARANSKI",
"authorized_official_first_name": "KENNETH",
"authorized_official_title_or_position": "VP/CFO",
"authorized_official_telephone_number": "989-269-1510"
},
"taxonomies": [
{
"code": "261QR1300X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rural Health",
"state": "MI",
"license": "1060000058",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "THUMB CONVENIENT CARE CLINIC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Bad Axe, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.