NPIMap

Organization Active NPI

Family Medical Center of Michigan, Inc

  • Federally Qualified Health Center (FQHC)
  • Adrian, MI
National Provider Identifier
1457640930
Registry record updated Oct 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 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
Last updated
Oct 14, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2014

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

Authorized official

Name
Mr. Ed Larkins
Title
Executive Director
Phone
(734) 850-6914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

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

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1457640930. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
1200 N Main St
Adrian, MI 49221-1759

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Ada Rodriguez Individual Corporate DirectorBoard of Directors Mar 1, 2025
Ed Larkins Individual Corporate Director Mar 22, 2004
Operational/Managerial ControlCeo Mar 22, 2004
Shirley Elaine Troxell - Robson Individual Corporate DirectorBoard of Directors Jul 1, 2011
Walter Tylicki Individual Corporate Officer Jan 3, 2005
Corporate Director Jan 3, 2000
Charles Watkins Individual Corporate DirectorBoard of Directors Jun 1, 2006
David Brown Individual Corporate OfficerBoard of Directors-President Jan 3, 1995
Corporate DirectorBoard of Directors-President Dec 1, 1987
Alma Salyer Individual Corporate DirectorBoard of Directors Jan 3, 1995
Burt Fenby Individual Corporate DirectorBoard of Directors Sep 1, 2009
John Langer Individual Corporate DirectorBoard of Directors Apr 1, 2013
Stella Abraham Individual Corporate DirectorBoard of Directors Dec 1, 2024
Kathleen Virginia Vanetten Individual Corporate DirectorBoard of Directors Mar 21, 2020
Christina Wright Individual Corporate DirectorBoard of Directors Mar 1, 2023
Kathleen a Busen Individual Corporate DirectorBoard of Directors Jun 1, 1997

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1301961600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413244800000",
    "number": "1457640930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 LEWIS AVE",
            "city": "TEMPERANCE",
            "state": "MI",
            "postal_code": "481829583",
            "telephone_number": "734-847-3802",
            "fax_number": "734-850-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 N MAIN ST",
            "city": "ADRIAN",
            "state": "MI",
            "postal_code": "492211759",
            "telephone_number": "517-263-1800",
            "fax_number": "517-263-1866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER OF MICHIGAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-05",
        "last_updated": "2014-10-14",
        "status": "A",
        "authorized_official_last_name": "LARKINS",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "734-850-6914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Adrian, MI

Sources for this page

Verify at the official NPI Registry.