Kalkaska Memorial Health Center
Organization Active NPI Family Medicine Physician · Mancelona, MI
NPI 1922870575 · NPPES record last updated Sep 18, 2025
Key facts
- NPI
- 1922870575
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 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
- Organization subpart
- Yes
- Parent organization (as reported)
- KALKASKA MEMORIAL HEALTH CENTER
Authorized official
- Name
- Mr. Andrew Richard Raymond
- Title
- President/Ceo
- Phone
- (231) 258-3651
Other NPIs on the same Medicare enrollment 6
Practitioners 6
-
Blair Alicia Brown, MD, MPH
-
Thomas A Minor, PA-C
-
Jennifer Sampson, MSN, RN, FNP-BC
-
Craig Sheerin, PA-C
-
Alexis Kilbourn, PA
-
Jennifer A Leino, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
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 |
National Provider Directory
- Part of
- Kalkaska Memorial Healt
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist |
103TC0700X | |||
| Family Medicine Physician |
207Q00000X | Yes |
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
Other providers in Mancelona, MI
- Michelle Renae Green
- Teri A Grody
- Kristy Hutchison
- Michael Max James
- Kalkaska Memorial Health Center
- Alexis Kilbourn
- Kimberly M Laforest
- Lakeshore Helping Hands Home Care
- Jennifer A Leino
- Matthew Robert Lewis
All providers in Mancelona, MI · Family Medicine Physician 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.