NPIMap

Organization Active NPI

Kalkaska Memorial Health Center

Doing business as Kalkaska Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Kalkaska, MI
National Provider Identifier
1891980306
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
KALKASKA MEMORIAL HEALTH CENTER
Doing business as
Kalkaska Dialysis Center
Practice address
415 2ND St.
Kalkaska, MI 49646
Phone
(231) 258-3680
Fax
(231) 258-3695
NPI assigned
Sep 7, 2007
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2025

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

Authorized official

Name
Mr. Andrew Raymond
Title
President/Ceo
Phone
(231) 258-3651

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X MI Primary

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 names 1

  • Kalkaska Dialysis Center Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs with the same Medicare PAC ID 4

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.

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Kalkaska Dialysis CenterCCN 232645
Overall star rating
3.0 of 5
Ownership
Non-profit
Certified
Mar 17, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
12

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

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
23D2041630Kalkaska Dialysis Center415 2ND Street, Kalkaska, MI 49646Certificate of waiverMay 24, 2028

National Provider Directory

National Provider Directory

Locations

415 Second St
Kalkaska, MI 49646
Phone (231) 258-3680

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Kalkaska Memorial Health CenterKalkaska, MI, CCN 231301 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 30, 2010
Kalkaska Memorial Health CenterKalkaska, MI, CCN 23Z301 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 30, 2010
Kalkaska Memorial Health CenterKalkaska, MI, CCN 235407 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%)
Adp of the SNF		 Jan 1, 1990
Dec 27, 2024

Owned or controlled facilities with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1891980306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4062 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-5652",
            "fax_number": "231-935-7792"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 2ND ST.",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "49646",
            "telephone_number": "231-258-3680",
            "fax_number": "231-258-3695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALKASKA MEMORIAL HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-07",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "231-258-3651",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kalkaska Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kalkaska Dialysis Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalkaska, MI

Sources for this page

Verify at the official NPI Registry.