NPIMap

Organization Active NPI

McLaren Northern Michigan

  • General Acute Care Hospital
  • Petoskey, MI
National Provider Identifier
1992812580
Registry record updated Apr 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
1060000053 Issued in MI
Legal business name
MCLAREN NORTHERN MICHIGAN
Practice address
416 Connable Ave
Petoskey, MI 49770-2212
Phone
(231) 487-4000
Fax
(231) 487-4552
NPI assigned
Aug 23, 2006
Last updated
Apr 15, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2022

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

Authorized official

Name
Michael Prusaitis
Title
Cfo
Phone
(559) 450-3375

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 1060000053 MI Primary

Addresses

Primary practice location

416 Connable Ave
Petoskey, MI 49770-2212

Mailing address

416 Connable Ave
Petoskey, MI 49770-2212
Phone (231) 487-7684

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030319000000 MI Part A Provider - Hospital 9931018181 1 other NPI on this enrollment
Practice locations: Petoskey, MI; Gaylord, MI; Cheboygan, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1992812580. Details of each certification follow.

Hospital certification: CCN 230105

Legal name
MCLAREN NORTHERN MICHIGAN
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jun 1, 1977
Last certification
Oct 31, 2015
Beds
243 (229 certified)
Ownership / control type
Other
Organization structure
CorporationNon-profit
Enrollment address
416 Connable Ave
Petoskey, MI 49770-2212
Main/Primary Hospital Location
Hospital subgroups
Acute care

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Hospital

Medicare Care Compare
Listed as
McLaren Northern MichiganCCN 230105 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Mark C Antonishen MD PC4 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

416 Connable Ave
#71
Petoskey, MI 49770

560 W Mitchell St
Ste C303
Petoskey, MI 49770

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Christine Gebhard Individual Corporate DirectorTrustee Jan 30, 2025
Matthew Frentz Individual Corporate DirectorTrustee Feb 1, 2021
Patricia Hemingway Hall Individual Corporate DirectorTrustee Feb 1, 2021
Chad Grant Individual Corporate DirectorCoo & MHC Corp Designee Aug 7, 2021
Craig Rogerson Individual Corporate DirectorTrustee Mar 1, 2023
Michael Loria Individual Corporate DirectorTrustee Jan 31, 2024
McLaren Health Care Corporation Organization, Grand Blanc, MI Non-profit, Chain home office 5% Or Greater Direct Ownership Interest Jan 1, 2012
Garfield H Atchison Individual Corporate OfficerPresident/Ceo Dec 20, 2023
Corporate DirectorPresident/Ceo Dec 20, 2023
Operational/Managerial ControlPresident/Ceo Dec 20, 2023
Arthur Hailand Individual Corporate DirectorTrustee Oct 28, 2024
Julie Fasone-Holder Individual Corporate DirectorTrustee Feb 1, 2017
Michael Prusaitis Individual Corporate OfficerCfo Mar 29, 2021
W-2 Managing EmployeeCfo Mar 29, 2021
Operational/Managerial ControlCfo Mar 29, 2021
Dennis Bryon Hesselink Individual Corporate DirectorTrustee Feb 1, 2017
Elise F Hayes Individual Corporate DirectorTrustee Feb 1, 2019
Thomas Cattel Individual Corporate DirectorTrustee Feb 1, 2019

All facility ownership & control disclosures 1

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

FacilityTypeRoleSince
Boulder Park TerraceCharlevoix, MI, CCN 235526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (75%) Jan 1, 2013

Owned or controlled facilities with NPI records 1

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 36

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 36

Affiliated clinicians 431

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

View all 431

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649980800000",
    "number": "1992812580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-7684",
            "fax_number": "231-487-7721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 CONNABLE AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702212",
            "telephone_number": "231-487-4000",
            "fax_number": "231-487-4552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCLAREN NORTHERN MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-23",
        "last_updated": "2022-04-15",
        "certification_date": "2022-04-15",
        "status": "A",
        "authorized_official_last_name": "PRUSAITIS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "559-450-3375"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MI",
            "license": "1060000053",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.