NPIMap

Organization Active NPI

McLaren Bay Region

  • Family Medicine Physician
  • Prudenville, MI
National Provider Identifier
1629357090
Registry record updated Aug 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MCLAREN BAY REGION
Practice address
200 Grand Ave
Prudenville, MI 48651
Phone
(989) 366-1000
Fax
(989) 366-1002
NPI assigned
Aug 16, 2011
Last updated
Aug 7, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2018

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

Authorized official

Name
Danielle C Jacks Porter
Title
Cfo
Phone
(989) 894-3838

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Family Nurse Practitioner 363LF0000X
Gerontology Nurse Practitioner 363LG0600X
Pediatric Nurse Practitioner 363LP0200X
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

200 Grand Ave
Prudenville, MI 48651

Mailing address

200 Grand Ave
PO Box 679
Prudenville, MI 48651-9571
Phone (989) 366-1000

National Provider Directory

National Provider Directory
Tax ID family
Bay Regional Medical Center16 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

NPI Registry JSON

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

{
    "created_epoch": "1313452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533600000000",
    "number": "1629357090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE",
            "address_2": "PO BOX 679",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "486519571",
            "telephone_number": "989-366-1000",
            "fax_number": "989-366-1002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 GRAND AVE",
            "city": "PRUDENVILLE",
            "state": "MI",
            "postal_code": "48651",
            "telephone_number": "989-366-1000",
            "fax_number": "989-366-1002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN BAY REGION",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-16",
        "last_updated": "2018-08-07",
        "status": "A",
        "authorized_official_last_name": "JACKS PORTER",
        "authorized_official_first_name": "DANIELLE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "989-894-3838"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Prudenville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.