NPIMap

Organization Active NPI

Paragon Health, P.C.

Doing business as Southwest Michigan Dermatology

  • Dermatology Physician
  • Portage, MI
National Provider Identifier
1902847098
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
PARAGON HEALTH, P.C.
Doing business as
Southwest Michigan Dermatology
Practice address
3000 Old Centre Rd
Portage, MI 49024-4883
Phone
(269) 321-7546
Fax
(269) 321-1705
NPI assigned
Jun 9, 2006
Last updated
Jan 12, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
PARAGON HEALTH, P.C.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Authorized official

Name
Dr. Mark C. Rummel, M.D.
Title
President
Phone
(269) 341-4554

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
MOHS-Micrographic Surgery Physician 207ND0101X NU
Procedural Dermatology Physician 207NS0135X NU

Addresses

Primary practice location

3000 Old Centre Rd
Portage, MI 49024-4883

Mailing address

3000 Old Centre Rd
Portage, MI 49024-4883
Phone (269) 321-7546

Other identifiers 2

IdentifierTypeStateIssuer
CN8688OtherRAILROAD MEDICARE
070C910440OtherMIBLUE CROSS & BLUE SHIELD

Other names 1

  • Southwest Michigan Dermatology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080115000329 MI Part B Supplier - Clinic/Group Practice 1658283007 Receives reassigned benefits from 20 practitioners
Practice locations: Paw Paw, MI; Three Rivers, MI; Saint Joseph, MI; Portage, MI; Kalamazoo, MI; Allegan, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

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
23D0948005Southwest Michigan Dermatology3000 Old Centre Road, Portage, MI 49024ComplianceOct 12, 2026

National Provider Directory

National Provider Directory
Part of
Paragon Health PC

Locations

2750 Old Centre Rd
Portage, MI 49024

3000 Old Centre Rd
Portage, MI 49024
Phone (269) 657-1417

2570 Niles Rd
Ste 105
Saint Joseph, MI 49085

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 25

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.

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1902847098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 OLD CENTRE RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244883",
            "telephone_number": "269-321-7546",
            "fax_number": "269-321-1705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 OLD CENTRE RD",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490244883",
            "telephone_number": "269-321-7546",
            "fax_number": "269-321-1705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARAGON HEALTH, P.C.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PARAGON HEALTH, P.C.",
        "enumeration_date": "2006-06-09",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "RUMMEL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "269-341-4554",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CN8688",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "070C910440",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Michigan Dermatology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southwest Michigan Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.