Hospice of Michigan, Inc.
Organization Active NPI Community Based Hospice Care Agency · Gaylord, MI
NPI 1962446237 · NPPES record last updated Nov 26, 2024
Key facts
- NPI
- 1962446237
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Community Based Hospice Care Agency 251G00000X
- Legal business name
- HOSPICE OF MICHIGAN, INC.
- Practice address
- 830 S Otsego Ave
Gaylord, MI 49735-1776 - Phone
- (989) 731-2744
- NPI assigned
- Jun 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Lee Ann Myers
- Title
- Chief Administrative Officer
- Phone
- (734) 718-5037
Owners & managing parties with NPI records 1
-
Shaz Shuja Anwar, D.O.
Owned or controlled facilities with NPI records 5
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 3
Affiliated clinicians 13
-
Paul D Blanchard, M.D.
-
David Dennis Dargis, D.O.
-
Dennis Feihel, MD
-
Carrie L. Kovolski, FNP-C
-
Michelle M Lafave, M.D.
-
Jessica Machue, MD
-
Kristin S Maschke, M.D.
-
Tabitha Carolin Pardo, FNP-C
-
Raj Rao, M.D
-
Stephen Clovis Sheridan, M.D.
-
Steven John Wisniewski, M.D.
Medicare Care Compare: Hospice
- Listed as
- Hospice of Northeastern Michigan
- Ownership
- Non-Profit
- Certified
- Aug 3, 1990
- Medicare certification status
- Active
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2086548 | Hospice of Michigan, Inc | Certificate of waiver | Nov 5, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Hospice certification: CCN 231536
- Legal name
- HOSPICE OF MICHIGAN, INC.
- Doing business as
- HOSPICE OF NORTHEASTERN MICHIGAN
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Aug 3, 1990
- Last certification
- Nov 11, 2011
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 20, 1978 in MI
- Enrollment address
- 830 S Otsego Ave
Gaylord, MI 49735-1776
All disclosed owners & managing parties 23
| Name | Role | Since | Share |
|---|---|---|---|
| Michael L Damstra |
Corporate Director |
Jan 1, 2018 | |
| Sanford J Linden |
Corporate Director |
Sep 9, 2005 | |
| Bradley Killaly |
Corporate Director |
Feb 22, 2023 | |
| Marcie M Hillary |
Corporate Officer |
Jan 26, 2011 | |
| Patrick Miller |
Corporate Officer |
Mar 6, 2014 | |
| Corporate Director |
Jan 1, 2024 | ||
| Brian M Connolly |
Corporate Director |
Feb 15, 2012 | |
| Eric Kaplan |
Corporate Officer |
May 1, 2025 | |
| Lee Ann Myers |
Corporate Officer |
Jan 1, 2012 | |
| W-2 Managing Employee | Jan 1, 2012 | ||
| Molly Petersen |
Corporate Director |
Aug 1, 2025 | |
| Krista Newman |
Corporate Officer |
Jan 1, 2024 | |
| Mary Sanders |
Corporate Director |
Sep 9, 2005 | |
| Kurt Ludlow |
Corporate Director |
Nov 12, 2009 | |
| Steven C Wade |
Corporate Director |
Jan 1, 2024 | |
| John Evangelisita |
Corporate Director |
Jan 1, 2014 | |
| Melissa D Ring |
W-2 Managing Employee |
Feb 1, 2024 | |
| Gerald Fitzgerald |
Corporate Director |
Dec 1, 2007 | |
| Joanna Szejbach |
W-2 Managing Employee |
Sep 12, 2021 | |
| Shaz Shuja Anwar |
W-2 Managing Employee |
Aug 14, 2022 | |
| John Raymond Maurer |
Corporate Director |
Sep 9, 2005 | |
| Jane McNamara |
Corporate Director |
Sep 9, 2005 | |
| Nancy Lynn Philappart |
Corporate Director |
Jan 1, 2024 | |
| Jamie L Cockerel |
Corporate Officer |
May 1, 2025 | |
| Michael a Jones |
Corporate Director |
Aug 1, 2025 |
All facility ownership & control disclosures 5
| Facility | Type | Role | Since |
|---|---|---|---|
| Hospice of Southeastern Michigan, Inc |
Hospice | Operational/Managerial Control (100%) | Sep 30, 1994 |
| Centrica Care Navigators |
Hospice | Operational/Managerial Control | Feb 1, 2024 |
| Hospice of Western Michigan, Inc. |
Hospice | Operational/Managerial Control (100%) | Jan 1, 1987 |
| Hospice of Mecosta County |
Hospice | Operational/Managerial Control (100%) | Sep 30, 1994 |
| Arbor Hospice and Home Care |
Hospice | 5% Or Greater Direct Ownership Interest (100%) | Jan 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050702000007 | MI | Part a Provider - Hospice | 5496723660 | Practice locations: Alpena, MI; Charlevoix, MI; Gaylord, MI |
National Provider Directory
- Tax ID family
- Hospice of Michigan Inc
Locations
830 S Otsego Ave
Gaylord, MI 49735
Phone (888) 247-5701
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | Yes |
Addresses
Primary practice location
830 S Otsego Ave
Gaylord, MI 49735-1776
Mailing address
2366 Oak Valley Dr
Ann Arbor, MI 48103-8944
Phone (989) 358-4280
Other practice location 1
199 Long Rapids Rd
Alpena, MI 49707-1351
Phone (989) 358-4280
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08758 | Other | MI | BLUE CROSS BLUE SHIELD |
| 151796120 | Medicaid | MI |
Other names
- Hospice of Northeastern Michigan
Other providers in Gaylord, MI
- Vicki Holloway
- Kathryn Mae Holmes
- Christopher Alan Hope
- Lori L Hopp
- Timothy R Hord
- Nicholas House
- Brian Michael Hoyner
- Heather Hresja
- Kelly Wray Hughes
- Susan E. Hughes
All providers in Gaylord, MI · Community Based Hospice Care Agency in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 26, 2024. 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.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.