NPIMap

Organization Active NPI

McLaren Port Huron

  • Clinical Social Worker
  • Port Huron, MI
National Provider Identifier
1467788018
Registry record updated Jul 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
AG643729 Issued in MI
Legal business name
MCLAREN PORT HURON
Doing business as
PORT HURON HOSPITAL PHYSICIAN GRP
Practice address
1209 Richardson St
Port Huron, MI 48060-3548
Phone
(810) 984-5156
NPI assigned
Nov 2, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2020

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

Authorized official

Name
Bridget Sholtis
Title
VP/Cfo
Phone
(810) 989-3749

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101Y00000X EB086434 MI
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X AG643729 MI Primary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X LK034456 MI
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X RM088438 MI

Addresses

Primary practice location

1209 Richardson St
Port Huron, MI 48060-3548

Mailing address

1221 Pine Grove Ave
Port Huron, MI 48060-3511
Phone (810) 984-5156

Other identifiers 1

IdentifierTypeStateIssuer
7509106270OtherMIBCBS

Other names 1

  • PORT HURON HOSPITAL PHYSICIAN GRP Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040204000779 MI Part B Supplier - Clinic/Group Practice 9931018702 Receives reassigned benefits from 90 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Clair, MI; Port Huron, MI; Fort Gratiot, MI; East China, MI; Deckerville, MI

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory

Locations

1209 Richardson St
Port Huron, MI 48060
Phone (810) 984-5156

NPI Registry JSON

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

{
    "created_epoch": "1257120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1596067200000",
    "number": "1467788018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 PINE GROVE AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603511",
            "telephone_number": "810-984-5156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1209 RICHARDSON ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603548",
            "telephone_number": "810-984-5156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN PORT HURON",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-02",
        "last_updated": "2020-07-30",
        "certification_date": "2020-07-30",
        "status": "A",
        "authorized_official_last_name": "SHOLTIS",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "810-989-3749"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": "MI",
            "license": "EB086434",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "AG643729",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "LK034456",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "RM088438",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "7509106270",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PORT HURON HOSPITAL PHYSICIAN GRP",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "PORT HURON HOSPITAL PHYSICIAN GRP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.