NPIMap

Organization Active NPI

Isabella Citizens for Health Inc

Doing business as Farwell Health Center of Isabella Citizens for Health Inc

  • Federally Qualified Health Center (FQHC)
  • Farwell, MI
National Provider Identifier
1548090491
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
ISABELLA CITIZENS FOR HEALTH INC
Doing business as
Farwell Health Center of Isabella Citizens for Health Inc
Practice address
522 E Main St
Farwell, MI 48622-9118
Phone
(989) 953-5320
NPI assigned
Aug 6, 2024
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Lydia Rose Stevens
Title
Lead Ehr/Rev Cycle Coordinator
Phone
(989) 779-5642

Specialties & licenses 1

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

Addresses

Primary practice location

522 E Main St
Farwell, MI 48622-9118

Mailing address

2790 Health Pkwy
Mt Pleasant, MI 48858-6934

Other names 1

  • Farwell Health Center of Isabella Citizens for Health Inc Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130516000164 MI Part B Supplier - Clinic/Group Practice 9335386051 Receives reassigned benefits from 38 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farwell, MI; Mount Pleasant, MI
O20241015000722 MI Part A Provider - Federally Qualified Health Center (FQHC) 9335386051 Practice locations: Farwell, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1548090491. Details of each certification follow.

Federally qualified health center certification: CCN C71036

Legal name
ISABELLA CITIZENS FOR HEALTH INC
Doing business as
FARWELL HEALTH CENTER OF ISABELLA CITIZENS FOR HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 1, 2024
Last certification
Oct 1, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
522 E Main St
Farwell, MI 48622-9118

Other NPIs with the same Medicare PAC ID 4

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Tax ID family
Isabella Citizens for Health Inc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

515 E Elizabeth St
Alma, MI 48801

400 Webster St
Ithaca, MI 48847

710 N Union St
Ithaca, MI 48847

2940 Health Pkwy
Mt Pleasant, MI 48858
Phone (989) 466-2877

312 Union St
Saint Louis, MI 48880

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
James Wojcik Individual Corporate DirectorBoard Member Nov 2, 2021 5%
Lisa Hadden Individual Corporate Director Feb 2, 2021 5%
Michael L McConnon Individual W-2 Managing EmployeeMD; Jan 1, 2018 5%
Albert Kaufmann Individual Corporate Director Oct 10, 2011 5%
Jennifer L White Individual Corporate OfficerCeo May 24, 2013 7%
W-2 Managing EmployeeAd; May 24, 2013 5%
Alisha Koutz Individual W-2 Managing EmployeeCredentialing Specialist Oct 1, 2023
Helen L Lee Individual Corporate DirectorBoard Member Sep 28, 2011 5%
Anthony Kulick Individual Corporate DirectorBoard Member Feb 1, 2016 5%
Leanne K Barton Individual Corporate DirectorBoard Member Sep 28, 2011 5%
Cheri Hall Individual Corporate Director Dec 3, 2024
Mary Ann O'Neil Individual Corporate DirectorBoard Member Feb 1, 2022 5%
Steven Hall Individual Corporate Director Sep 8, 2014 5%
Brian Ross Individual W-2 Managing EmployeeChief Financial Officer Sep 1, 2024
Rachel Blizzard Individual W-2 Managing EmployeeDirector of Operations Dec 1, 2021 5%
Jen Crawford Individual Corporate DirectorBoard Member Feb 16, 2018 5%
Brad Wahr Individual Corporate DirectorBoard Member Feb 1, 2022 5%
Tara Hovey Individual Corporate Director Feb 1, 2022 5%

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 2

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

FacilityTypeRoleSince
Isabella Citizens for Health IncMt Pleasant, MI, CCN 231038 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Feb 11, 2013
Women's Health Center of Isabella Citizens for Health, IncMt Pleasant, MI, CCN C71005 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 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 37

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 37

NPI Registry JSON

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

{
    "created_epoch": "1722902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1548090491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 HEALTH PKWY",
            "city": "MT PLEASANT",
            "state": "MI",
            "postal_code": "488586934"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "522 E MAIN ST",
            "city": "FARWELL",
            "state": "MI",
            "postal_code": "486229118",
            "telephone_number": "989-953-5320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ISABELLA CITIZENS FOR HEALTH INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-06",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "STEVENS",
        "authorized_official_first_name": "LYDIA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "LEAD EHR/REV CYCLE COORDINATOR",
        "authorized_official_telephone_number": "989-779-5642"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Farwell Health Center of Isabella Citizens for Health Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Farwell, MI

Sources for this page

Verify at the official NPI Registry.