BLUE WATER INTERNAL MEDICINE, PC
NPI 1255967667
Internal Medicine in Port Huron, MI
About Blue Water Internal Medicine, Pc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLUE WATER INTERNAL MEDICINE, PC (NPI 1255967667) is a healthcare organization registered as an internal medicine in Port Huron, Michigan and active in the NPI registry since March 2020. The organization holds a CLIA Waiver certificate valid through April 19, 2028 and lists Nikki Hack, Practice Manager, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
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 Internal Medicine, Pc 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 Internal Medicine, PC, which bills Medicare for the services they deliver. Of these, 4 practice at this address. 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 23D2182318
Blue Water Internal Medicine PC · Port Huron, 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 Internal Medicine, PC's NPI number?
The NPI number for Blue Water Internal Medicine, PC is 1255967667. It was assigned to this organization in the NPPES registry on March 17, 2020.
Where is Blue Water Internal Medicine, PC located?
Blue Water Internal Medicine, PC is located at 1210 10th Ave, Port Huron, MI 48060. The listed phone number is (810) 622-3505.
What is Blue Water Internal Medicine, PC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is Blue Water Internal Medicine, PC enrolled in Medicare?
Yes. Blue Water Internal Medicine, PC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Blue Water Internal Medicine, PC?
According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians in 2 Medicare specialties reassign their Medicare billing to Blue Water Internal Medicine, PC. 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. The largest specialties are Nurse Practitioner (3) and Internal Medicine (1). Of these, 4 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does Blue Water Internal Medicine, PC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D2182318) is associated with this NPI, valid through April 19, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does Blue Water Internal Medicine, PC accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Blue Water Internal Medicine, PC 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 Internal Medicine, PC was last updated on November 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 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 Internal Medicine, Pc · NPI 1255967667
Internal Medicine organization in Port Huron, Michigan. Organization record, active in the CMS NPPES registry since March 17, 2020.
## Identity
- **NPI:** 1255967667 (Entity type: Organization)
- **Enumerated:** March 17, 2020
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Organization subpart:** No
- **Authorized official:** Nikki Hack, PRACTICE MANAGER
## Practice location
- **Address:** 1210 10TH AVE, Port Huron, MI 48060-3406
- **Phone:** (810) 622-3505 · **Fax:** (810) 662-3479
## 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: Nurse Practitioner (3), Internal Medicine (1); 4 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 18, 2024
- **Other identifiers:** Other 4301076169 (MI)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1255967667) · Data from the CMS NPPES public registry.