NPIMap

Organization Active NPI

Mymichigan Medical Center Sault

  • Rural Health Clinic/Center
  • Sault Sainte Marie, MI
National Provider Identifier
1720145303
Registry record updated Jan 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MYMICHIGAN MEDICAL CENTER SAULT
Practice address
509 Osborn Blvd
Sault Sainte Marie, MI 49783-2069
Phone
(906) 635-4460
NPI assigned
Jan 2, 2007
Organization subpart
Yes
Parent organization
MYMICHIGAN MEDICAL CENTER SAULTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 14, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

509 Osborn Blvd
Sault Sainte Marie, MI 49783-2069

Mailing address

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

Other names 1

  • MyMichigan Community Care Clinic Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040512000662 MI Part B Supplier - Clinic/Group Practice 7315936481 Receives reassigned benefits from 191 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Sault Sainte Marie, MI; Sault S Marie, MI; Cedarville, MI; Saint Ignace, MI; Newberry, MI; Mackinaw City, MI; Kincheloe, MI; Drummond Island, MI…
O20100915000230 MI Part A Provider - Rural Health Clinic 7315936481 Practice locations: Sault Sainte Marie, MI

Rural health clinic certification: CCN 238541

Legal name
MYMICHIGAN MEDICAL CENTER SAULT
Doing business as
MYMICHIGAN COMMUNITY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 23, 1996
Last certification
Mar 27, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
509 Osborn Blvd
Sault Sainte Marie, MI 49783-2069
Related CCNs
230239

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 12

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

Other NPIs on the same Medicare enrollment 6

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

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
23D2116636Mymichigan Community Care - Sault509 Osborn Blvd Suite 160 M O B, Sault Sainte Marie, MI 49783Certificate of waiverJul 28, 2028

National Provider Directory

National Provider Directory
Part of
Chippewa Cnty War Memorial

Locations

391 E M 134
Cedarville, MI 49719
Phone (906) 484-2295

33896 S Townline Rd
Drummond Island, MI 49726
Phone (906) 322-1815

509 Osborn Blvd
Ste 422
Sault Sainte Marie, MI 49783
Phone (906) 253-9770

1138 W 3 Mile Rd
Sault Sainte Marie, MI 49783
Phone (906) 253-0137

333 Magazine St
Sault South Marie, MI 49783
Phone (906) 253-9374

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
Scott Shackleton Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Holly Kibble Individual Corporate DirectorBoard Member Nov 1, 2014 10%
Charles Palmer Individual Corporate Officer Jan 1, 2020
Ralph J Duman Individual Corporate Officer Jan 1, 2018
Thomas Coates Individual Corporate Officer Jan 1, 2019
Kyle P Raycraft Individual Corporate Officer Jan 1, 2020
Mark Savoie Individual Corporate Officer Jan 1, 2019
Samantha Hunter Individual W-2 Managing Employee Feb 19, 2025
Marla Bunker Individual Corporate OfficerVP of Nursing Jan 1, 2012 30%
W-2 Managing EmployeeDirector of Nursing Jan 1, 2012 10%
Theodore Postula Individual Corporate DirectorBoard Member Jan 1, 2012 10%
Tina Church Individual Corporate Director Aug 15, 2024
Maxine Anderson Individual Corporate DirectorBoard Member Jan 1, 2014 10%
Tricia Gorde Individual Corporate DirectorDirector, Provider Enrollment Jan 20, 2025

Owners & managing parties with NPI records 2

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
Mymichigan Primary Care DrummondDrummond Island, MI, CCN 238767 Rural health clinic Operational/Managerial Control (100%) Aug 24, 2023

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 108

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

View all 108

NPI Registry JSON

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

{
    "created_epoch": "1167696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1768348800000",
    "number": "1720145303",
    "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": "509 OSBORN BLVD",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497832069",
            "telephone_number": "906-635-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MYMICHIGAN MEDICAL CENTER SAULT",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MYMICHIGAN MEDICAL CENTER SAULT",
        "enumeration_date": "2007-01-02",
        "last_updated": "2026-01-14",
        "certification_date": "2026-01-14",
        "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": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MyMichigan Community Care Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.