BLUE WATER PRIMARY CARE
NPI 1013896638
Family Medicine in Fort Gratiot, MI
About Blue Water Primary Care NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLUE WATER PRIMARY CARE (NPI 1013896638) is a healthcare organization registered as a family medicine in Fort Gratiot, Michigan and active in the NPI registry since August 2025. The organization holds a CLIA Waiver certificate valid through February 23, 2028 and lists Ibrahim Dabaja, Chief Operating Officer, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Blue Water Primary Care is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
4Medicare enrollment records show 4 clinicians reassign Medicare billing to Blue Water Primary Care, which bills Medicare for the services they deliver. They are listed nearest first.
Clinicians, nearest first (4)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 23D2339100
Blue Water Primary Care · Fort Gratiot, MIFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Blue Water Primary Care's NPI number?
The NPI number for Blue Water Primary Care is 1013896638. It was assigned to this organization in the NPPES registry on August 28, 2025.
Where is Blue Water Primary Care located?
Blue Water Primary Care is located at 3953 24th Ave, Fort Gratiot, MI 48059. The listed phone number is (734) 299-0712.
What is Blue Water Primary Care's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Blue Water Primary Care enrolled in Medicare?
Yes. Blue Water Primary Care is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Blue Water Primary Care?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Blue Water Primary Care, in Family Practice and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Blue Water Primary Care hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D2339100) is associated with this NPI, valid through February 23, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Blue Water Primary Care accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Blue Water Primary Care as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Blue Water Primary Care was last updated on January 28, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Blue Water Primary Care · NPI 1013896638
Family Medicine organization in Fort Gratiot, Michigan. Organization record, active in the CMS NPPES registry since August 28, 2025.
## Identity
- **NPI:** 1013896638 (Entity type: Organization)
- **Enumerated:** August 28, 2025
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Ibrahim Dabaja, CHIEF OPERATING OFFICER
## Practice location
- **Address:** 3953 24TH AVE, Fort Gratiot, MI 48059-4193
- **Phone:** (734) 299-0712
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 4 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Family Practice (2), Nurse Practitioner (2) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 28, 2026
- **CLIA laboratory certificates:** 1 on file
---
Source: [NPI Profile](https://npiprofile.com/npi/1013896638) · Data from the CMS NPPES public registry.