NPIMap

Organization Active NPI

Hospice of Michigan, Inc.

Doing business as Hospice of Northeastern Michigan

  • Community Based Hospice Care Agency
  • Gaylord, MI
National Provider Identifier
1962446237
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE OF MICHIGAN, INC.
Doing business as
Hospice of Northeastern Michigan
Practice address
830 S Otsego Ave
Gaylord, MI 49735-1776
Phone
(989) 731-2744
NPI assigned
Jun 16, 2006
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Lee Ann Myers
Title
Chief Administrative Officer
Phone
(734) 718-5037

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

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 names 1

  • Hospice of Northeastern Michigan Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050702000007 MI Part A Provider - Hospice 5496723660 Practice locations: Alpena, MI; Charlevoix, MI; Gaylord, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962446237. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 20, 1978 in MI
Enrollment address
830 S Otsego Ave
Gaylord, MI 49735-1776

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: Hospice

Medicare Care Compare
Listed as
Hospice of Northeastern MichiganCCN 231536 · All quality measures
Ownership
Non-Profit
Certified
Aug 3, 1990
Medicare certification status
ActiveFrom the Provider of Services file

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
23D2086548Hospice of Michigan, Inc830 S Otsego Ave, Gaylord, MI 49735Certificate of waiverNov 5, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hospice of Michigan Inc4 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.

Locations

400 Galleria Officentre
Ste 400
Southfield, MI 48034
Phone (248) 353-2070

Ownership & related parties

All disclosed owners & managing parties 23

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

NameRoleSinceShare
Michael L Damstra Individual Corporate DirectorBoard Member Jan 1, 2018
Sanford J Linden Individual Corporate DirectorBoard Member Sep 9, 2005
Bradley Killaly Individual Corporate DirectorBoard Member Feb 22, 2023
Marcie M Hillary Individual Corporate OfficerChief Experience Officer Jan 26, 2011
Patrick Miller Individual Corporate OfficerChief Executive Officer Mar 6, 2014
Corporate DirectorPresident & Ceo Jan 1, 2024
Brian M Connolly Individual Corporate DirectorBoard Member Feb 15, 2012
Eric Kaplan Individual Corporate OfficerVice President May 1, 2025
Lee Ann Myers Individual Corporate OfficerChief Administrative Officer Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Molly Petersen Individual Corporate DirectorBoard Member Aug 1, 2025
Krista Newman Individual Corporate OfficerChief Operating Officer Jan 1, 2024
Mary Sanders Individual Corporate DirectorBoard Member Sep 9, 2005
Kurt Ludlow Individual Corporate DirectorBoard Member Nov 12, 2009
Steven C Wade Individual Corporate DirectorBoard Member Jan 1, 2024
John Evangelisita Individual Corporate DirectorBoard Member Jan 1, 2014
Melissa D Ring Individual W-2 Managing EmployeeAssociate Vice President Feb 1, 2024
Gerald Fitzgerald Individual Corporate DirectorBoard Member Dec 1, 2007
Joanna Szejbach Individual W-2 Managing EmployeeAdministrator Sep 12, 2021
Shaz Shuja Anwar Individual W-2 Managing EmployeeMedical Director Aug 14, 2022
John Raymond Maurer Individual Corporate DirectorBoard Member Sep 9, 2005
Jane McNamara Individual Corporate DirectorBoard Member Sep 9, 2005
Nancy Lynn Philappart Individual Corporate DirectorBoard Member Jan 1, 2024
Jamie L Cockerel Individual Corporate OfficerChief Financial Officer May 1, 2025
Michael a Jones Individual Corporate DirectorBoard Member Aug 1, 2025

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 5

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

FacilityTypeRoleSince
Hospice of Southeastern Michigan, IncSouthfield, MI, CCN 231501 Hospice Operational/Managerial Control (100%) Sep 30, 1994
Centrica Care NavigatorsKalamazoo, MI, CCN 231505 Hospice Operational/Managerial Control Feb 1, 2024
Hospice of Western Michigan, Inc.Ada, MI, CCN 231510 Hospice Operational/Managerial Control (100%) Jan 1, 1987
Hospice of Mecosta CountyBig Rapids, MI, CCN 231556 Hospice Operational/Managerial Control (100%) Sep 30, 1994
Arbor Hospice and Home CareAnn Arbor, MI, CCN 231526 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016

Owned or controlled facilities with NPI records 5

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

Practitioners & affiliated clinicians

Affiliated clinicians 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1150416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1962446237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2366 OAK VALLEY DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481038944",
            "telephone_number": "989-358-4280"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351776",
            "telephone_number": "989-731-2744"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "199 Long Rapids Rd",
            "address_purpose": "LOCATION",
            "city": "Alpena",
            "state": "MI",
            "postal_code": "497071351",
            "country_code": "US",
            "telephone_number": "989-358-4280",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOSPICE OF MICHIGAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-16",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-26",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "LEE ANN",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "734-718-5037"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Northeastern Michigan",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hospice of Northeastern Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.