Charles R Barker Jr DO Family Practice PC
Organization Active NPI Rural Health Clinic/Center · Belding, MI
NPI 1962595546 · NPPES record last updated Feb 15, 2024
Key facts
- NPI
- 1962595546
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- License
- 5101013251 (MI)
- Legal business name
- CHARLES R BARKER JR DO FAMILY PRACTICE PC
- Practice address
- 1320 W State St
Ste 3a
Belding, MI 48809-9245 - Phone
- (616) 794-1810
- Fax
- (616) 794-1947
- NPI assigned
- Oct 2, 2006
- Organization subpart
- No
Authorized official
- Name
- Charles Robert Barker, DO
- Title
- President/Owner
- Phone
- (616) 794-1810
Owners & managing parties with NPI records 1
Practitioners 7
-
Olivia Rose Borchers, PA-C
-
Emily Wallace, PA-C
-
Kyleigh Linn Fusee, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D1020290 | Charles R Barker Jr DO | Certificate of waiver | Dec 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Rural health clinic certification: CCN 238917
- Legal name
- CHARLES R BARKER JR DO FAMILY PRACTICE PC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Aug 5, 2011
- Last certification
- May 7, 2025
- Ownership / control type
- 1B
- Organization structure
- Corporation · Proprietary
- Incorporated
- Oct 1, 2003 in MI
- Enrollment address
- 1320 W State St
Suite 3a
Belding, MI 48809-9245
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Charles R Barker |
5% Or Greater Direct Ownership Interest |
Aug 5, 2011 | 100% |
| 5% Or Greater Mortgage Interest |
Aug 5, 2011 | 100% | |
| 5% Or Greater Security Interest |
Aug 5, 2011 | 100% | |
| Corporate Officer |
Aug 5, 2011 | 100% | |
| Corporate Director |
Aug 5, 2011 | 100% | |
| W-2 Managing Employee |
Aug 5, 2011 | 90% | |
| Operational/Managerial Control |
Aug 5, 2011 | 100% | |
| Kimberly Prendergast |
W-2 Managing Employee |
Dec 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040226000683 | MI | Part B Supplier - Clinic/Group Practice | 2163318049 |
Receives reassigned benefits from 7 practitioners Practice locations: Belding, MI |
| O20100309000895 | MI | Part a Provider - Rural Health Clinic | 2163318049 | Practice locations: Belding, MI |
National Provider Directory
Locations
215 E State St
Ste D
Belding, MI 48809
Phone (616) 794-1810
1320 W State St
Ste 3A
Belding, MI 48809
Phone (616) 794-1810
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Family Medicine) Physician |
207QS0010X | CB013251 | MI | |
| Rural Health Clinic/Center | 261QR1300X | 5101013251 | MI | Yes |
Addresses
Primary practice location
1320 W State St
Ste 3a
Belding, MI 48809-9245
Mailing address
1320 W State Street
Suite 3a
Belding, MI 48809-9245
Phone (616) 794-1810
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4569538 | Medicaid | MI |
Other providers in Belding, MI
- Braintree Management, Inc.
- McKenzie Brouwer
- Carrie Lynn Bucholtz
- Cheri Lorraine Bull-Huerta
- C3 - Ciluffo Counseling and Consulting
- Emily Chilcote
- Judie Lynne Chorman
- Kyasia Dominique Comelleri
- Matthew D Cooper
- Maya N Deciechi
All providers in Belding, MI · Rural Health Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 15, 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.