Mymichigan Medical Center Standish
Organization Active NPI Rural Health Clinic/Center · Standish, MI
NPI 1720166010 · NPPES record last updated Jan 13, 2026
Key facts
- NPI
- 1720166010
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- MYMICHIGAN MEDICAL CENTER STANDISH
- Practice address
- 805 W Cedar St
Standish, MI 48658-9526 - Phone
- (989) 846-4521
- Fax
- (989) 846-3541
- NPI assigned
- Nov 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Sarah James
- Title
- Manager Patient Accounting
- Phone
- (989) 701-4734
Owners & managing parties with NPI records 4
-
Jo Studley May, MD
Owned or controlled facilities with NPI records 1
Other NPIs on the same Medicare enrollment 3
Other NPIs with the same Medicare PAC ID 2
Related certifications (CCN) 1
Facilities with the same owner 30
Practitioners 7
-
Brodi Katelyn Lynch, M.D.
-
Thomas Kane, NP
-
Melissa Marie Nixon, FNP
-
Cynthia Michelle Payne, M.D.
-
Andrew Allan Slocum, MSN, FNP-BC
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0987747 | Mymichigan Family Medicine Clinic - Standish | Certificate of waiver | Apr 20, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Rural health clinic certification: CCN 233998
- Legal name
- MYMICHIGAN MEDICAL CENTER STANDISH
- Doing business as
- MYMICHIGAN FAMILY MEDICINE
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- May 26, 1995
- Last certification
- Oct 22, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 805 W Cedar St
Standish, MI 48658-9526 - Related CCNs
- 231305
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Mymichigan Medical Center Standish |
Operational/Managerial Control | Aug 1, 2024 | 100% |
| Marcia Mastracci Ditmyer |
Corporate Officer | Aug 1, 2024 | |
| Bapineedu Maganti |
Corporate Officer | Aug 1, 2024 | |
| Mary Catherine Hannah |
Corporate Director | Aug 1, 2024 | |
| Steve Meyer |
Corporate Director | Aug 1, 2024 | |
| Laurilee McCord |
W-2 Managing Employee |
Jul 1, 2018 | 5% |
| Other |
Jul 1, 2018 | ||
| Samantha Hunter |
W-2 Managing Employee | Aug 1, 2024 | |
| Heather Bauman |
Corporate Officer | Aug 1, 2024 | |
| Mymichigan Health |
5% Or Greater Direct Ownership Interest | Aug 1, 2024 | 100% |
| Michael Erickson |
Corporate Officer | Aug 1, 2024 | |
| Mark Flegenheimer |
Corporate Officer | Aug 1, 2024 | |
| Andrew Bethune |
Corporate Officer | Aug 1, 2024 | |
| Jo S May |
Corporate Officer |
Jul 1, 2017 | |
| Jimmy Greene |
Corporate Officer | Aug 1, 2024 |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Mymichigan Skilled Nursing Facility |
Skilled nursing facility | 5% Or Greater Indirect Ownership Interest (100%) | Aug 1, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080703000459 | MI | Part a Provider - Rural Health Clinic | 0840362224 | Practice locations: Standish, MI |
| O20120114000064 | MI | Part B Supplier - Clinic/Group Practice | 0840362224 |
Receives reassigned benefits from 16 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Standish, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
805 W Cedar St
Standish, MI 48658-9526
Mailing address
4000 Wellness Dr
Midland, MI 48670-2000
Phone (844) 832-1956
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720166010 | Medicaid | MI |
Other names
- Ascension Standish Hospital Standish Family Medicine
- MYMICHIGAN FAMILY MEDICINE
Other providers in Standish, MI
- Alexis Morgan
- Jessica Lee Mowbray
- Muhammed R Mirza MD
- Mymichigan Medical Center Standish
- Mymichigan Medical Center Standish
- Mymichigan Medical Center Standish
- Alivia Diana Nadell
- Robin Robertta Nadell
- Karen Nelson
- Dezary Rose Nichols
All providers in Standish, MI · Rural Health Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.