NPIMap

Organization Active NPI

Mymichigan Medical Center Gladwin

  • Certified Registered Nurse Anesthetist
  • Gladwin, MI
National Provider Identifier
1508993361
Registry record updated Jan 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MYMICHIGAN MEDICAL CENTER GLADWIN
Practice address
515 Quarter Street
Gladwin, MI 48624-1959
Phone
(989) 426-9286
Fax
(989) 839-1304
NPI assigned
Feb 28, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2026

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

Authorized official

Name
Sarah James
Title
Manager, Provider Enrollment
Phone
(989) 701-4734

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

515 Quarter Street
Gladwin, MI 48624-1959

Mailing address

4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956

Other identifiers 1

IdentifierTypeStateIssuer
430B610020OtherMIBL SHIELD CRNA GROUP

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081024000094 MI Part B Supplier - Clinic/Group Practice 0143262915 Receives reassigned benefits from 191 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gladwin, MI; West Branch, MI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 24

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

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768435200000",
    "number": "1508993361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 WELLNESS DR",
            "city": "MIDLAND",
            "state": "MI",
            "postal_code": "486702000",
            "telephone_number": "844-832-1956",
            "fax_number": "989-633-5241"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 QUARTER STREET",
            "city": "GLADWIN",
            "state": "MI",
            "postal_code": "486241959",
            "telephone_number": "989-426-9286",
            "fax_number": "989-839-1304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYMICHIGAN MEDICAL CENTER GLADWIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2026-01-15",
        "certification_date": "2026-01-15",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "MANAGER, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "989-701-4734"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BL SHIELD CRNA GROUP",
            "identifier": "430B610020",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gladwin, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2026; 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.