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MICHIGAN MASONIC HOME
NPI 1285465633
Family Medicine - Geriatric Medicine in Alma, MI

Active since August 08, 2024CLIA 23D0928520 · Waiver
1200 WRIGHT AVE, ALMA, MI 48801(989) 466-3864(989) 463-8921 Get Directions Write a Review

NPPES record last updated: August 8, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Michigan Masonic Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MICHIGAN MASONIC HOME (NPI 1285465633), doing business as Masonic Pathways, is a healthcare organization registered as a geriatric medicine in Alma, Michigan and active in the NPI registry since August 2024. The organization holds a CLIA Waiver certificate valid through May 19, 2027 and lists Michelle L Shaw, Health Information Services/clinic, as its authorized official.

NPPES Registry Identity

NPI1285465633
Entity TypeOrganization
Primary Taxonomy207QG0300X
Legal Business NameMICHIGAN MASONIC HOME
Location Address1200 WRIGHT AVEAlma, MI 48801-1133
Mailing Address1200 Wright AveAlma, MI 48801-1133 · (989) 466-3864 · Fax (989) 463-8921
Phone(989) 466-3864
Fax(989) 463-8921
Organization SubpartNo
Authorized OfficialMichelle L ShawHealth Information Services/clinic · (989) 466-3864
Enumeration DateAugust 8, 2024
NPPES CertifiedAugust 8, 2024
✔ NPI 1285465633 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily Medicine · Geriatric MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207QG0300X
Definition
A family medicine physician with special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes, and the hospital.
1200 WRIGHT AVE, Alma, MI 48801
Open in Google Maps ↗

Other Names 1

Doing Business AsMasonic Pathways

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.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)

Michigan Masonic Home is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Michigan Masonic Home, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Prakash Sarvepalli, M.D.
Internal Medicine
NPI 1669411310
1021 E. MAIN STREET
Edmore, MI 48829
(989) 427-5320
✔ PECOS✔ Accepts Medicare19 mi
Ladawn Logic, FNP-C
Nurse Practitioner
NPI 1174812135
529 S OAK ST
Evart, MI 49631
(231) 734-9058
✔ PECOS✔ Accepts Medicare47 mi

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 23D0928520

Michigan Masonic Home · Alma, MI
Active · expires May 19, 2027
CLIA Number23D0928520
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateMay 20, 2025
Certificate Expiration DateMay 19, 2027
Laboratory DirectorPrakash Sarvepalli
Laboratory Phone(989) 466-3865
Laboratory LocationMichigan Masonic Home1200 Wright Avenue, Alma, MI 48801
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

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 Michigan Masonic Home's NPI number?

The NPI number for Michigan Masonic Home is 1285465633. It was assigned to this organization in the NPPES registry on August 8, 2024. The provider is doing business as Masonic Pathways.

Where is Michigan Masonic Home located?

Michigan Masonic Home is located at 1200 Wright Ave, Alma, MI 48801. The listed phone number is (989) 466-3864.

What is Michigan Masonic Home's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Geriatric Medicine, with taxonomy code 207QG0300X.

Is Michigan Masonic Home enrolled in Medicare?

Yes. Michigan Masonic Home is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Michigan Masonic Home?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Michigan Masonic Home, in Internal Medicine 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 Michigan Masonic Home hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D0928520) is associated with this NPI, valid through May 19, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Michigan Masonic Home accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Michigan Masonic Home 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 Michigan Masonic Home was last updated on August 8, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.