NPIMap

Organization Active NPI

Family Medical Center of Michigan, Inc

  • Federally Qualified Health Center (FQHC)
  • Monroe, MI
National Provider Identifier
1780975276
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
FAMILY MEDICAL CENTER OF MICHIGAN, INC
Practice address
1001 S Raisinville Rd
Monroe, MI 48161-9754
Phone
(734) 243-7340
NPI assigned
May 2, 2011
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Authorized official

Name
Mr. Ed Larkins
Title
Executive Director
Phone
(734) 850-6914

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X MI Primary

Addresses

Primary practice location

1001 S Raisinville Rd
Monroe, MI 48161-9754

Mailing address

8765 Lewis Ave
Temperance, MI 48182-9583
Phone (734) 847-3802

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070910000059 MI Part B Supplier - Clinic/Group Practice 2769575653 Receives reassigned benefits from 35 practitioners
8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Adrian, MI; Carleton, MI; Monroe, MI; Temperance, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1780975276. Details of each certification follow.

  • CCN 231958 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 231958

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
FAMILY MEDICAL CENTER OF MICHIGAN, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 26, 2011
Last certification
May 26, 2011
Ownership / control type
Non-profit – church related
Facility address
1001 South Raisinville
Monroe, MI 48161

Other NPIs on the same Medicare enrollment 8

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1304294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1780975276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8765 LEWIS AVE",
            "city": "TEMPERANCE",
            "state": "MI",
            "postal_code": "481829583",
            "telephone_number": "734-847-3802",
            "fax_number": "734-850-0520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 S RAISINVILLE RD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481619754",
            "telephone_number": "734-243-7340"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICAL CENTER OF MICHIGAN, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-02",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "LARKINS",
        "authorized_official_first_name": "ED",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "734-850-6914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, MI

Sources for this page

Verify at the official NPI Registry.