NPIMap

Organization Active NPI

Kalkaska Memorial Health Center

  • Family Medicine Physician
  • Mancelona, MI
National Provider Identifier
1922870575
Registry record updated Sep 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
KALKASKA MEMORIAL HEALTH CENTER
Practice address
419 W State St
Mancelona, MI 49659-9651
Phone
(231) 587-9181
Fax
(231) 587-0923
NPI assigned
Oct 26, 2023
Last updated
Sep 18, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
KALKASKA MEMORIAL HEALTH CENTERAs reported in NPPES

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 Richard Raymond
Title
President/Ceo
Phone
(231) 258-3651

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

419 W State St
Mancelona, MI 49659-9651

Mailing address

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7500

Medicare participation

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

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory
Part of
Kalkaska Memorial Healt

Practitioners & affiliated clinicians

Practitioners 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1698278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1758153600000",
    "number": "1922870575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503",
            "telephone_number": "231-258-7500",
            "fax_number": "231-258-7527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 W STATE ST",
            "city": "MANCELONA",
            "state": "MI",
            "postal_code": "496599651",
            "telephone_number": "231-587-9181",
            "fax_number": "231-587-0923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KALKASKA MEMORIAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KALKASKA MEMORIAL HEALTH CENTER",
        "enumeration_date": "2023-10-26",
        "last_updated": "2025-09-18",
        "certification_date": "2025-09-18",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "231-258-3651",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mancelona, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2025; 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.