NPIMap

Organization Active NPI

Dickinson County Healthcare System

Doing business as Dickinson Medical Services at Bayside Clinic

  • General Practice Physician
  • Gladstone, MI
National Provider Identifier
1821345646
Registry record updated Aug 24, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
DICKINSON COUNTY HEALTHCARE SYSTEM
Doing business as
Dickinson Medical Services at Bayside Clinic
Practice address
2001 Minneapolis Ave
Suite E
Gladstone, MI 49837-2060
Phone
(906) 428-2000
NPI assigned
Aug 10, 2012
Last updated
Aug 24, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2012

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

Authorized official

Name
Alicia Henderson
Title
Physician Billing Supervisor
Phone
(906) 776-5665

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207N00000X
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Orthopaedic Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207X00000X
Urology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208800000X
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X Primary
PodiatristGroup: 193200000X MULTI-SPECIALTY GROUP 213E00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

2001 Minneapolis Ave
Suite E
Gladstone, MI 49837-2060

Mailing address

PO Box 549
Iron Mountain, MI 49801-0549
Phone (906) 774-1313

Other names 1

  • Dickinson Medical Services at Bayside Clinic Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050623000153 MI Part B Supplier - Clinic/Group Practice 6800784943 Receives reassigned benefits from 13 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Iron Mountain, MI; Norway, MI; Marquette, MI; Kingsford, MI; Ishpeming, MI; Iron River, MI; Bark River, MI

Other NPIs on the same Medicare enrollment 13

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

View all 13

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1344556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345766400000",
    "number": "1821345646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 549",
            "city": "IRON MOUNTAIN",
            "state": "MI",
            "postal_code": "498010549",
            "telephone_number": "906-774-1313",
            "fax_number": "906-776-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 MINNEAPOLIS AVE",
            "address_2": "SUITE E",
            "city": "GLADSTONE",
            "state": "MI",
            "postal_code": "498372060",
            "telephone_number": "906-428-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DICKINSON COUNTY HEALTHCARE SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-08-10",
        "last_updated": "2012-08-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "PHYSICIAN BILLING SUPERVISOR",
        "authorized_official_telephone_number": "906-776-5665"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Orthopaedic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "213E00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dickinson Medical Services at Bayside Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gladstone, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.