NPIMap

Individual provider Active NPI

Martha E Koglin, PA-C

  • Physician Assistant
  • Port Austin, MI
National Provider Identifier
1992014898
Registry record updated Mar 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005895 Issued in MI
Practice address
24 E Spring St
Port Austin, MI 48467-6736
Phone
(989) 738-5222
Fax
(989) 738-5224
NPI assigned
Sep 27, 2010
Last updated
Mar 21, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005895 MI Primary

Addresses

Primary practice location

24 E Spring St
Port Austin, MI 48467-6736

Mailing address

24 E Spring St
Port Austin, MI 48467-6736
Phone (989) 738-5222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101217000902 MI Practitioner - Physician Assistant 3779771647 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
McLaren Thumb RegionGroup PAC ID 6800709221, 39 clinicians

Practice addresses (Care Compare)

1040 S Van Dyke Rd
Bad Axe, MI 48413-9646
Phone (989) 269-6911

1100 S Van Dyke
Bad Axe, MI 48413-9615

1100 S Van Dyke Rd
Bad Axe, MI 48413-9615
Phone (989) 269-9521

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
McLaren Thumb Region CurrentSince Oct 4, 2010 Accepting new patients
Huron Pathology Services PC Current Accepting new patients
McLaren Thumb Region Current Accepting new patients
McLaren Thumb Region CurrentSince Oct 4, 2010 Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients
Great Lakes Bay Health Centers Past Accepting new patients

Locations

1040 S Van Dyke Rd
Ste 1
Bad Axe, MI 48413
Phone (989) 269-6432

1100 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-9521

24 E Spring St
Port Austin, MI 48467
Phone (989) 738-4017

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1285545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1992014898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 E SPRING ST",
            "city": "PORT AUSTIN",
            "state": "MI",
            "postal_code": "484676736",
            "telephone_number": "989-738-5222",
            "fax_number": "989-738-5224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 E SPRING ST",
            "city": "PORT AUSTIN",
            "state": "MI",
            "postal_code": "484676736",
            "telephone_number": "989-738-5222",
            "fax_number": "989-738-5224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOGLIN",
        "first_name": "MARTHA",
        "middle_name": "E",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-27",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005895",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Austin, MI

Sources for this page

Verify at the official NPI Registry.