NPIMap

Organization Active NPI

Center for Family Health

  • Federally Qualified Health Center (FQHC)
  • Jackson, MI
National Provider Identifier
1710764410
Registry record updated Jun 6, 2024
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
300 S Blackstone St
Jackson, MI 49201-2204
Phone
(517) 539-8620
Fax
(517) 539-5668
NPI assigned
Sep 14, 2023
Last updated
Jun 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Authorized official

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

Specialties & licenses 13

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU
Clinical Social Worker 1041C0700X NU
Family Medicine Physician 207Q00000X NU
Internal Medicine Physician 207R00000X NU
Obstetrics & Gynecology Physician 207V00000X NU
Pediatrics Physician 208000000X NU
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Physician Assistant 363A00000X NU
Nurse Practitioner 363L00000X NU
Adult Health Nurse Practitioner 363LA2200X NU
Family Nurse Practitioner 363LF0000X NU
Pediatric Nurse Practitioner 363LP0200X NU
Women's Health Clinical Nurse Specialist 364SW0102X NU

Addresses

Primary practice location

300 S Blackstone St
Jackson, MI 49201-2204

Mailing address

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

Other names 1

  • Center for Family Health Blackstone Other name

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
O20240117002211 MI Part A Provider - Federally Qualified Health Center (FQHC) 4587574421 Practice locations: Jackson, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710764410. Details of each certification follow.

Federally qualified health center certification: CCN C71014

Legal name
CENTER FOR FAMILY HEALTH
Doing business as
CENTER FOR FAMILY HEALTH- BLACKSTONE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 9, 2024
Last certification
Jan 9, 2024
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 1, 1995 in MI
Enrollment address
300 S Blackstone St
Jackson, MI 49201-2204

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 Hlthi10 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.

Locations

240 W Carleton Rd
Hillsdale, MI 49242
Phone (517) 437-7040

1100 E Michigan Ave
Ste 202
Jackson, MI 49201
Phone (517) 787-6210

300 S Blackstone St
Jackson, MI 49201
Phone (517) 539-8620

414 S Blackstone St
Jackson, MI 49201
Phone (517) 206-5682

6700 Rives Junction Rd
Jackson, MI 49201
Phone (517) 569-3200

817 W High St
Jackson, MI 49203
Phone (517) 782-9905

Ownership & related parties

All disclosed owners & managing parties 13

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 OfficerCeo Dec 1, 2023
Corporate DirectorCeo May 30, 2023
W-2 Managing EmployeeCeo May 30, 2023 100%
Randall Wesley Treacher Individual Corporate OfficerBoard Member Dec 1, 2023
Alisa Marie Anders Individual Corporate OfficerBoard Member Jan 1, 2024
Zoe Lynn Lyons Individual Corporate OfficerBoard Member Dec 1, 2023
Jacob Inosencio Individual Corporate OfficerBoard Member Jan 1, 2024
Jessica Marie Embury Individual Corporate OfficerBoard Member Dec 1, 2023
Shawna Marie Tello Individual Corporate OfficerBoard Member Jan 1, 2024
Lori Heiler Individual Corporate OfficerBoard Member Dec 1, 2023
Center for Family Health Organization, Jackson, MI Corporation, Non-profit Operational/Managerial Control Dec 1, 2023 100%
Ralph Dale Moretz Individual Corporate OfficerBoard Member Dec 1, 2023
Sheila Troxel Individual Corporate OfficerBoard Member Jan 1, 2024
Theodore Hilleary Individual Corporate OfficerBoard Member Dec 1, 2023
Jennifer White Individual Corporate OfficerBoard Member Dec 1, 2023

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 1

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

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 55

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 55

NPI Registry JSON

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

{
    "created_epoch": "1694649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1710764410",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 S BLACKSTONE ST",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012204",
            "telephone_number": "517-539-8620",
            "fax_number": "517-539-5668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR FAMILY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-14",
        "last_updated": "2024-06-06",
        "certification_date": "2024-06-06",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PATIENT ACCOUNTS MANAGER",
        "authorized_official_telephone_number": "517-748-5500"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "364SW0102X",
            "taxonomy_group": "",
            "desc": "Clinical Nurse Specialist, Women's Health",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Center for Family Health Blackstone",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Center for Family Health Blackstone",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.