Kalkaska Memorial Health Center
Organization Active NPI End-Stage Renal Disease (ESRD) Treatment Clinic/Center · Kalkaska, MI
NPI 1891980306 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1891980306
- Entity type
- Organization (NPI type 2)
- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X
- Legal business name
- KALKASKA MEMORIAL HEALTH CENTER
- Practice address
- 415 2ND St.
Kalkaska, MI 49646 - Phone
- (231) 258-3680
- Fax
- (231) 258-3695
- NPI assigned
- Sep 7, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Andrew Raymond
- Title
- President/Ceo
- Phone
- (231) 258-3651
Owned or controlled facilities with NPI records 2
Other NPIs on the same Medicare enrollment 6
Other NPIs with the same Medicare PAC ID 4
Practitioners 58
-
David Thomas Auer, PA-C
-
Andrew S Boyce, MD
-
Blair Alicia Brown, MD, MPH
-
James Casey, DO
-
Roberto A Corpus Jr., M.D.
-
Eric Covert, PA-C
-
Maria I Cupp, PA-C
-
Michael Delaney, M.D.
-
Marissa Fischer, PA-C
-
Anthony Craig Hockin, PHD
-
Richard E Hodgman, M.D.
-
Jeremy K Holmes, DO
-
Sharon Marie Johnson, P.A.-C
-
Molly Kidner, FNP-BC
-
Alexis Kilbourn, PA
-
Marc S Krakow, M.D.
Affiliated clinicians 1
-
John William Stanifer, M.D.
Medicare Care Compare: Dialysis facility
- Listed as
- Kalkaska Dialysis Center
- Overall star rating
- ★★★☆☆ 3.0 of 5
- Ownership
- Non-profit
- Certified
- Mar 17, 2008
- Medicare certification status
- Active
- Dialysis stations
- 12
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2041630 | Kalkaska Dialysis Center | Certificate of waiver | May 24, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
All facility ownership & control disclosures 3
| Facility | Type | Role | Since |
|---|---|---|---|
| Kalkaska Memorial Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 30, 2010 |
| Kalkaska Memorial Health Center |
Hospital | 5% Or Greater Direct Ownership Interest (100%) | Aug 30, 2010 |
| Kalkaska Memorial Health Center |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Adp of the SNF |
Jan 1, 1990 Dec 27, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040813000668 | MI | Part B Supplier - Clinic/Group Practice | 3577536002 |
Receives reassigned benefits from 111 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Kalkaska, MI; Mancelona, MI |
| O20071023000359 | MI | Part a Provider - End-Stage Renal Disease Facility (ESRD) | 3577536002 | Practice locations: Kalkaska, MI |
National Provider Directory
Locations
415 Second St
Kalkaska, MI 49646
Phone (231) 258-8053
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | MI | Yes |
Addresses
Primary practice location
415 2ND St.
Kalkaska, MI 49646
Mailing address
4062 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-5652
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D8982 | Other | MI | BCBSM PRIMARY |
| 1891980306 | Medicaid | MI | |
| 09417 | Other | MI | BCBSM -SUPPLEMENTAL |
Other names
- Kalkaska Dialysis Center
Other providers in Kalkaska, MI
- Kalkaska Memorial Health Center
- Kalkaska Memorial Health Center
- Kalkaska Memorial Health Center
- Kalkaska Memorial Health Center
- Kalkaska Memorial Health Center
- Kathryn Mancewicz LLC
- Emmaline Keely-Luhellier
- Brandi Jean Ketchum
- James Matthew Kik
- Jordanae Kimball
All providers in Kalkaska, MI · End-Stage Renal Disease (ESRD) Treatment 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 Sep 18, 2025. 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.