NPIMap

Organization Active NPI

McLaren Northern Michigan

  • Rehabilitation Hospital Unit
  • Petoskey, MI
National Provider Identifier
1942370754
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
Legal business name
MCLAREN NORTHERN MICHIGAN
Practice address
416 Connable Ave
Petoskey, MI 49770-2212
Phone
(231) 487-4000
Fax
(231) 487-4552
NPI assigned
Nov 9, 2006
Last updated
Apr 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Michael Prusaitis
Title
Cfo
Phone
(559) 450-3375

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X MI Primary
General Acute Care Hospital 282N00000X MI

Addresses

Primary practice location

416 Connable Ave
Petoskey, MI 49770-2212

Mailing address

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-7684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030326000004 MI Part A Provider - Hospital 9931018181 Practice locations: Petoskey, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942370754. Details of each certification follow.

Hospital certification: CCN 23T105

Legal name
MCLAREN NORTHERN MICHIGAN
Organization structure
CorporationNon-profit
Enrollment address
416 Connable Ave
Petoskey, MI 49770-2212
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
McLaren Northern MichiganCCN 23T105 · All quality measures
Ownership
Non-profit
Certified
Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
No Mi Hosprogers City4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 12

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Christine Gebhard Individual Corporate DirectorTrustee Jan 30, 2025
Matthew Frentz Individual Corporate DirectorTrustee Feb 1, 2021
Patricia Hemingway Hall Individual Corporate DirectorTrustee Feb 1, 2021
Chad Grant Individual Corporate DirectorCoo & MHC Corp Designee Aug 7, 2021
Craig Rogerson Individual Corporate DirectorTrustee Mar 1, 2023
Michael Loria Individual Corporate DirectorTrustee Jan 31, 2024
Philip a Incarnati Individual Corporate DirectorTrustee Jan 1, 2012
Garfield H Atchison Individual Corporate OfficerPresident/Ceo Dec 20, 2023
Corporate DirectorPresident/Ceo Dec 20, 2023
Operational/Managerial ControlPresident/Ceo Dec 20, 2023
McLaren Health Care Corporation Organization, Grand Blanc, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2012 100%
Arthur Hailand Individual Corporate DirectorTrustee Oct 28, 2024
Julie Fasone-Holder Individual Corporate DirectorTrustee Feb 1, 2017
Michael Prusaitis Individual Corporate OfficerCfo Mar 29, 2021
W-2 Managing EmployeeCfo Mar 29, 2021
Operational/Managerial ControlCfo Mar 29, 2021
Dennis Bryon Hesselink Individual Corporate DirectorTrustee Feb 1, 2017
Elise F Hayes Individual Corporate DirectorTrustee Feb 1, 2019
Thomas Cattel Individual Corporate DirectorTrustee Feb 1, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boulder Park TerraceCharlevoix, MI, CCN 235526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (75%) Jan 1, 2013

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 58

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 58

Practitioners & affiliated clinicians

Practitioners 1

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": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1942370754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-7684",
            "fax_number": "231-487-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4000",
            "fax_number": "231-487-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN NORTHERN MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "PRUSAITIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "559-450-3375"
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.