| Bay Mills Indian Community | |
|
12455 W Lakeshore Dr Brimley MI 49715-9319 | |
| (906) 248-5527 | |
| (906) 248-5765 |
| Full Name | Bay Mills Indian Community |
|---|---|
| Speciality | Clinic/Center |
| Location | 12455 W Lakeshore Dr, Brimley, Michigan |
| Authorized Official Name and Position | Audrey Breakie (HEALTH DIRECTOR) |
| Authorized Official Contact | 9062488327 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bay Mills Indian Community 12455 W Lakeshore Dr Brimley MI 49715-9319 Ph: (906) 248-5527 | Bay Mills Indian Community 12455 W Lakeshore Dr Brimley MI 49715-9319 Ph: (906) 248-5527 |
| NPI Number | 1053592089 |
|---|---|
| Provider Enumeration Date | 11/19/2007 |
| Last Update Date | 06/09/2022 |
| Medicare PECOS PAC ID | 8729079918 |
|---|---|
| Medicare Enrollment ID | O20040518000950 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053592089 | NPI | - | NPPES |
| 1053592089 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 231839 (Michigan) | Primary |
| Provider Name | Renee A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1821297318 PECOS PAC ID: 0840184347 Enrollment ID: I20040213000161 |
| Provider Name | Robert James Devers |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922109636 PECOS PAC ID: 8022090877 Enrollment ID: I20040729000677 |
| Provider Name | William R Shouldice |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1275611246 PECOS PAC ID: 6800981374 Enrollment ID: I20070927000965 |
| Provider Name | Dolly M Furr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1245516152 PECOS PAC ID: 4284889536 Enrollment ID: I20130312000596 |
| Provider Name | Ashly Ellis |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285910984 PECOS PAC ID: 0749426575 Enrollment ID: I20130423000163 |
| Provider Name | Kevin C Nelson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1972923514 PECOS PAC ID: 4284857350 Enrollment ID: I20140516001436 |
| Provider Name | Daniel C Maloney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760421499 PECOS PAC ID: 7810934742 Enrollment ID: I20160428001258 |
| Provider Name | Zara Masood |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801220769 PECOS PAC ID: 9032496971 Enrollment ID: I20170503000333 |
| Provider Name | William L Malette |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1689082042 PECOS PAC ID: 8820363443 Enrollment ID: I20171009000988 |
| Provider Name | Karen J Perkins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1730738089 PECOS PAC ID: 5799016234 Enrollment ID: I20191014002549 |
| Provider Name | Shaylice M Meserole |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912372350 PECOS PAC ID: 9032409057 Enrollment ID: I20200804001665 |
| Provider Name | Danielle L Leblanc |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053923763 PECOS PAC ID: 9032538806 Enrollment ID: I20200928002088 |
| Provider Name | Bradley Baker |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386207967 PECOS PAC ID: 0749661080 Enrollment ID: I20220720003298 |
| Provider Name | Jill Irene Sayer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861500142 PECOS PAC ID: 2567834062 Enrollment ID: I20230209001899 |
Bay Mills Indian Community Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 12455 W Lakeshore Dr, Brimley, MI 49715 Phone: 906-248-5527 Fax: 906-248-5765 | |
Bay Mills Indian Community Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 7134 S M 221, Brimley, MI 49715 Phone: 906-248-5527 |