BLUE WATER INTERNAL MEDICINE, PC
NPI 1255967667
Internal Medicine in Port Huron, MI

Active since March 17, 2020CLIA 23D2182318 · Waiver
1210 10TH AVE, PORT HURON, MI 48060(810) 622-3505(810) 662-3479 Get Directions Write a Review

NPPES record last updated: November 18, 2024. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Nov 18, 2024, Oct 3, 2024, Sep 12, 2024 and 3 more (6 updates tracked since 2020).

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

NPI1255967667
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameBLUE WATER INTERNAL MEDICINE, PC
Location Address1210 10TH AVEPort Huron, MI 48060-3406
Mailing Address1210 10th AvePort Huron, MI 48060-3406 · (810) 662-3505 · Fax (810) 662-3479
Fax(810) 662-3479
Organization SubpartNo
Authorized OfficialNikki HackPractice Manager · (810) 662-3505
Enumeration DateMarch 17, 2020
Last NPPES UpdateNovember 18, 20246 updates tracked since enumeration
NPPES CertifiedNovember 18, 2024
NPI 1255967667 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition

A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.

1210 10TH AVE, Port Huron, MI 48060

Other Identifiers 1

Other4301076169MI · State Medical License

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

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, MI
Active · expires Apr 19, 2028
CLIA Number23D2182318
Laboratory TypePhysician Office
Certificate Effective DateApril 20, 2026
Certificate Expiration DateApril 19, 2028
Laboratory DirectorEmad Daher
Laboratory Phone(810) 662-3505
Laboratory LocationBlue Water Internal Medicine PC1210 10th Avenue, Port Huron, MI 48060
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Nurse Practitioner
1210 10TH AVE
PORT HURON, MI 48060
Surgery (Vascular Surgery)
1210 10TH AVE
PORT HURON, MI 48060
Internal Medicine (Pulmonary Disease)
1210 10TH AVE
PORT HURON, MI 48060
Nurse Practitioner (Family)
1210 10TH AVE
PORT HURON, MI 48060
Nurse Practitioner (Gerontology)
1210 10TH AVE
PORT HURON, MI 48060
Internal Medicine
1210 10TH AVE
PORT HURON, MI 48060
Nurse Practitioner (Family)
1210 10TH AVE
PORT HURON, MI 48060
Nurse Practitioner (Gerontology)
1210 10TH AVE
PORT HURON, MI 48060

Frequently 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.

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 with the weekly NPPES data releases published by CMS.