Martha E Koglin, PA-C
Individual provider Active NPI Physician Assistant · Port Austin, MI
NPI 1992014898 · NPPES record last updated Mar 21, 2013
Key facts
- NPI
- 1992014898
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5601005895 (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
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 22
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2010
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McLaren Thumb Region
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
- A&D Health Care Professional
- McLaren Thumb Region
- Harbor Beach Community Hospital
- Scheurer Hospital
- McLaren Bay Region
- McLaren Port Huron
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20101217000902 | MI | Practitioner - Physician Assistant | 3779771647 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5601005895 | MI | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Huron Pathology Services PC | Current | Accepting new patients | |
| McLaren Thumb Region | Current |
Accepting new patients | |
| McLaren Thumb Region | Current | Accepting new patients | |
| McLaren Thumb Region | Current |
Accepting new patients | |
| Great Lakes Bay Health Centers | Past | Accepting new patients | |
| Great Lakes Bay Health Centers | Past | Accepting new patients |
Locations
1100 S Van Dyke Rd
Bad Axe, MI 48413
Phone (989) 269-9521
1040 S Van Dyke Rd
Ste 1
Bad Axe, MI 48413
Phone (989) 269-6432
24 E Spring St
Port Austin, MI 48467
Phone (989) 269-1540
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601005895 | MI | Yes |
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
Other providers in Port Austin, MI
- Carl R Reichelt
- Charles Christensen
- DRC Cloud Care PLLC
- Heather McDermott PSYD PLLC
- Abigail Kasper-Ahearn
- Lakeview Professional Counseling, PLLC.
- Charles Mantey
- McLaren Thumb Region
- Marcella Mosey
- Noble Physical Therapy & Wellness PLLC
All providers in Port Austin, MI · Physician Assistant in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 21, 2013. 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.
- Order and Referring (CMS).
- 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.