NPIMap

Organization Active NPI

Center for Family Health

  • Federally Qualified Health Center (FQHC)
  • Jackson, MI
National Provider Identifier
1497825939
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CENTER FOR FAMILY HEALTH
Practice address
2400 4TH St
Jackson, MI 49203-4573
Phone
(517) 788-6812
Fax
(517) 788-7722
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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

Authorized official

Name
Ms. Michelle Mayo
Title
Patient Accounts.Manager
Phone
(517) 748-5500

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X MI
School Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041S0200X MI
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X MI
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MI
Federally Qualified Health Center (FQHC) 261QF0400X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X MI

Addresses

Primary practice location

2400 4TH St
Jackson, MI 49203-4573

Mailing address

505 N Jackson St
Jackson, MI 49201-1266
Phone (517) 748-5500

Other identifiers 2

IdentifierTypeStateIssuer
700C810070OtherMIBCBSM GROUP PROVIDER
500C807070OtherMIBCBSM GROUP NUMBER

Other names 1

  • Teen Center at Parkside Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mcaryl@cfhinc.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040219000916 MI Part B Supplier - Clinic/Group Practice 4587574421 Receives reassigned benefits from 52 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI
O20060119000254 MI Part A Provider - Federally Qualified Health Center (FQHC) 4587574421 Practice locations: Jackson, MI

Federally qualified health center certification: CCN 231913

Legal name
CENTER FOR FAMILY HEALTH
Doing business as
CENTER FOR FAMILY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 4, 2006
Last certification
May 4, 2006
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1995 in MI
Enrollment address
2400 4TH St
Jackson, MI 49203-4573
Related CCNs
231864

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).

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Center for Family Healt10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
William M Wypyski Individual Corporate DirectorCeo Nov 17, 2023
W-2 Managing EmployeeCeo Nov 17, 2023 100%
Randall Wesley Treacher Individual Corporate Officer Jun 1, 2016
Alisa Marie Anders Individual Corporate OfficerBoard Member Jan 1, 2024
Zoe Lynn Lyons Individual Corporate Officer Feb 1, 2019
Jacob Inosencio Individual Corporate OfficerBoard Member Jan 1, 2024
Jessica Marie Embury Individual Corporate Officer Nov 1, 2018
Shawna Marie Tello Individual Corporate OfficerBoard Member Jan 1, 2024
Lori Heiler Individual Corporate Officer Apr 1, 2007
Ralph Dale Moretz Individual Corporate Officer Sep 1, 2001
Sheila Troxel Individual Corporate OfficerBoard Member Jan 1, 2024
Jennifer White Individual Corporate Officer Apr 1, 2013
Tiphanie Salas Individual Corporate Director Jan 13, 2025
W-2 Managing EmployeeOffice Manager Jan 13, 2025

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Center for Family HealthJackson, MI, CCN 231953 Federally qualified health center Operational/Managerial Control (100%) May 31, 2023
Center for Family Health- BlackstoneJackson, MI, CCN C71014 Federally qualified health center Operational/Managerial Control (100%) Dec 1, 2023

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1497825939",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 N JACKSON ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011266",
            "telephone_number": "517-748-5500",
            "fax_number": "517-780-9286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 4TH ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492034573",
            "telephone_number": "517-788-6812",
            "fax_number": "517-788-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS.MANAGER",
        "authorized_official_telephone_number": "517-748-5500",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "1041S0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, School",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP PROVIDER",
            "identifier": "700C810070",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM GROUP NUMBER",
            "identifier": "500C807070",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mcaryl@cfhinc.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "2400 4th St",
            "city": "Jackson",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492034573",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Teen Center at Parkside",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Teen Center at Parkside",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.