NPIMap

Organization Active NPI

McLaren Thumb Region

Doing business as McLaren Thumb Region Primary Care - Ubly

  • Rural Health Clinic/Center
  • Ubly, MI
National Provider Identifier
1467510206
Registry record updated Nov 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MCLAREN THUMB REGION
Doing business as
McLaren Thumb Region Primary Care - Ubly
Practice address
2269 E Main St
Ubly, MI 48475-9573
Phone
(989) 658-2159
Fax
(989) 658-2192
NPI assigned
Dec 5, 2006
Last updated
Nov 14, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2024

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

Authorized official

Name
Kenneth Baranski
Title
Cfo
Phone
(989) 269-1510

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Medical Physician Assistant 363AM0700X RD002414 MI
Family Medicine Physician 207Q00000X RL040876 MI

Addresses

Primary practice location

2269 E Main St
Ubly, MI 48475-9573

Mailing address

1100 S Van Dyke Rd
Bad Axe, MI 48413-9615
Phone (989) 269-9521

Other names 1

  • McLaren Thumb Region Primary Care - Ubly Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040610000616 MI Part A Provider - Rural Health Clinic 6800709221 Practice locations: Ubly, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467510206. Details of each certification follow.

Rural health clinic certification: CCN 238586

Legal name
MCLAREN THUMB REGION
Doing business as
MCLAREN THUMB REGION PRIMARY CARE - UBLY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 5, 2003
Last certification
Jun 14, 2017
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
2269 E Main St
Ubly, MI 48475-9573
Related CCNs
231340

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

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
23D1001842McLaren Thumb Region Primary Care Ubly2269 Main Street, Ubly, MI 48475Certificate of waiverFeb 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Huron Memorial Hosp16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

2269 E Main St
Ubly, MI 48475
Phone (517) 658-8541

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Donald J Clark Individual Corporate DirectorDirector Nov 17, 1980
Kenneth E Baranski Individual Corporate OfficerVP/Cfo Apr 11, 2024
W-2 Managing EmployeeVP/Cfo Apr 11, 2024
Operational/Managerial ControlVP/Cfo Apr 11, 2024
John M Hunt Individual Corporate DirectorDirector Apr 8, 2013
Chad Grant Individual Corporate DirectorCoo & MHC Corp Designee Sep 20, 2021
Connie Koutouzos Individual Corporate OfficerPresident/Ceo Nov 15, 2021
W-2 Managing EmployeePresident/Ceo Nov 15, 2021
Operational/Managerial ControlPresident/Ceo Nov 15, 2021
McLaren Health Care Corporation Organization, Grand Blanc, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest May 11, 2018 100%
Mary C Rapson Individual Corporate DirectorDirector Nov 28, 2005

Facilities with the same owner 58

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 58

NPI Registry JSON

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731542400000",
    "number": "1467510206",
    "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": "2269 E MAIN ST",
            "city": "UBLY",
            "state": "MI",
            "postal_code": "484759573",
            "telephone_number": "989-658-2159",
            "fax_number": "989-658-2192"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN THUMB REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-05",
        "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": "CFO",
        "authorized_official_telephone_number": "989-269-1510"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "RD002414",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "RL040876",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "McLaren Thumb Region Primary Care - Ubly",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ubly, MI

Sources for this page

Verify at the official NPI Registry.