Family Medical Center of Michigan, Inc
Organization Active NPI Federally Qualified Health Center (FQHC) · Adrian, MI
NPI 1457640930 · NPPES record last updated Oct 14, 2014
Key facts
- NPI
- 1457640930
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federally Qualified Health Center (FQHC) 261QF0400X
- Legal business name
- FAMILY MEDICAL CENTER OF MICHIGAN, INC
- Practice address
- 1200 N Main St
Adrian, MI 49221-1759 - Phone
- (517) 263-1800
- Fax
- (517) 263-1866
- NPI assigned
- Apr 5, 2011
- Organization subpart
- No
Authorized official
- Name
- Mr. Ed Larkins
- Title
- Executive Director
- Phone
- (734) 850-6914
Other NPIs on the same Medicare enrollment 8
Other NPIs with the same Medicare PAC ID 3
Practitioners 40
-
Laith Khalil, DO
-
Charmin Marie Kuhn, PA-C
-
Dennis Wayne Simpson, MSN, PMHNP-BC
-
Le'Shay Webb, LPC
-
Nicholas Richard Wilson, PA-C
-
William F Pettit Jr., M.D.
-
Mark Thomas Koehl, M.D.
-
Regina South, PA-C
-
Sin-Ching Chiu, M.D.
-
Sarah Collins, NP
-
Latoya Shanell Colvin, LMSW
-
John Thomas Emerick, PA-C
-
Anastasia Floros, MD
-
Stephanie Harris, PMHNP
-
Serina J Hunter, LMSW
-
Ashley King, LMSW
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Federally qualified health center certification: CCN 231959
- Legal name
- FAMILY MEDICAL CENTER OF MICHIGAN INC
- Doing business as
- FAMILY MEDICAL CENTER OF MICHIGAN ADRIAN
- Certification status
- Active
- Provider type (POS)
- Federally qualified health center
- Participating since
- May 20, 2011
- Last certification
- May 20, 2011
- Ownership / control type
- Non-profit – church related
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 1200 N Main St
Adrian, MI 49221-1759
All disclosed owners & managing parties 13
| Name | Role | Since | Share |
|---|---|---|---|
| Ada Rodriguez |
Corporate Director |
Mar 1, 2025 | |
| Ed Larkins |
Corporate Director | Mar 22, 2004 | |
| Operational/Managerial Control |
Mar 22, 2004 | ||
| Shirley Elaine Troxell - Robson |
Corporate Director |
Jul 1, 2011 | |
| Walter Tylicki |
Corporate Officer | Jan 3, 2005 | |
| Corporate Director | Jan 3, 2000 | ||
| Charles Watkins |
Corporate Director |
Jun 1, 2006 | |
| David Brown |
Corporate Officer |
Jan 3, 1995 | |
| Corporate Director |
Dec 1, 1987 | ||
| Alma Salyer |
Corporate Director |
Jan 3, 1995 | |
| Burt Fenby |
Corporate Director |
Sep 1, 2009 | |
| John Langer |
Corporate Director |
Apr 1, 2013 | |
| Stella Abraham |
Corporate Director |
Dec 1, 2024 | |
| Kathleen Virginia Vanetten |
Corporate Director |
Mar 21, 2020 | |
| Christina Wright |
Corporate Director |
Mar 1, 2023 | |
| Kathleen a Busen |
Corporate Director |
Jun 1, 1997 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070910000059 | MI | Part B Supplier - Clinic/Group Practice | 2769575653 |
Receives reassigned benefits from 35 practitioners 8 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Adrian, MI; Carleton, MI; Monroe, MI; Temperance, MI |
| O20110413000090 | MI | Part a Provider - Federally Qualified Health Center (FQHC) | 2769575653 |
1 other NPI on this enrollment Practice locations: Adrian, MI |
National Provider Directory
Locations
130 Medical Center Dr
Carleton, MI 48117
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federally Qualified Health Center (FQHC) | 261QF0400X | Yes |
Addresses
Primary practice location
1200 N Main St
Adrian, MI 49221-1759
Mailing address
8765 Lewis Ave
Temperance, MI 48182-9583
Phone (734) 847-3802
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02214 | Other | PARAMOUNT HEALTH CARE |
Other providers in Adrian, MI
- Eye Center of Lenawee P.C.
- Faithful Journey Counseling and Coaching LLC
- Family Counseling and Children'S Services
- Family Medical Center of Mi, Inc
- Family Medical Center of Michigan, Inc
- Family Medical Center of Michigan, Inc
- Family Medical Center of Michigan, Inc
- Family Medical Center of Michigan,Inc
- Family Medical Center of Michigan,Inc
- Family Medical Center of Michigan,Inc
All providers in Adrian, MI · Federally Qualified Health Center (FQHC) in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.