NPIMap

Organization Active NPI

St. Charles Family Clinic PLLC

  • Family Medicine Physician
  • Saint Charles, MI
National Provider Identifier
1669837993
Registry record updated Mar 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301059644 Issued in MI
Legal business name
ST. CHARLES FAMILY CLINIC PLLC
Practice address
611 W Belle Avenue
Saint Charles, MI 48655
Phone
(989) 865-9958
Fax
(989) 865-8099
NPI assigned
Dec 31, 2015
Last updated
Mar 10, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2026

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

Authorized official

Name
Naveed Mahfooz, MDNPI 1780639450
Title
Owner
Phone
(989) 865-9958

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 4301059644 MI Primary

Addresses

Primary practice location

611 W Belle Avenue
Saint Charles, MI 48655

Mailing address

611 W Belle Ave
Saint Charles, MI 48655-1611
Phone (989) 865-9958

Other practice location 1

1277 E Cedar Ave
Gladwin, MI 48624-7004
Phone (989) 709-5515

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160610001414 MI Part B Supplier - Clinic/Group Practice 8527358035 Receives reassigned benefits from 10 practitioners
Practice locations: Gladwin, MI; Saint Charles, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0681685St Charles Family Clinic PLLC611 W Belle Avenue, Saint Charles, MI 48655Certificate of waiverApr 14, 2028

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 18

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 18

NPI Registry JSON

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

{
    "created_epoch": "1451520000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773100800000",
    "number": "1669837993",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W BELLE AVE",
            "city": "SAINT CHARLES",
            "state": "MI",
            "postal_code": "486551611",
            "telephone_number": "989-865-9958",
            "fax_number": "989-865-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W BELLE AVENUE",
            "city": "SAINT CHARLES",
            "state": "MI",
            "postal_code": "48655",
            "telephone_number": "989-865-9958",
            "fax_number": "989-865-8099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1277 E Cedar Ave",
            "address_purpose": "LOCATION",
            "city": "Gladwin",
            "state": "MI",
            "postal_code": "486247004",
            "country_code": "US",
            "telephone_number": "989-709-5515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. CHARLES FAMILY CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-31",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A",
        "authorized_official_last_name": "MAHFOOZ",
        "authorized_official_first_name": "NAVEED",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "989-865-9958",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301059644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Charles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.