NPIMap

Organization Active NPI

Henry Ford Health Providence Hospital

Doing business as Henry Ford Health Providence Novi Hospital

  • Psychiatric Hospital Unit
  • Southfield, MI
National Provider Identifier
1003892092
Registry record updated Jul 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric Hospital UnitTaxonomy code 273R00000X
Legal business name
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Doing business as
Henry Ford Health Providence Hospital
Henry Ford Health Providence Novi Hospital
Henry Ford Health Providence Southfield Hospital2 more in Other names
Practice address
16001 W. 9 Mile Road
Southfield, MI 48075-4818
Phone
(243) 349-3000
Fax
(248) 746-0384
NPI assigned
Dec 21, 2005
Last updated
Jul 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Robin Damschroder
Title
President, Val Based ENT &Cfo
Phone
(313) 876-8452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital Unit 273R00000X NU Primary

Addresses

Primary practice location

16001 W. 9 Mile Road
Southfield, MI 48075-4818

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 999-5829

Other identifiers 3

IdentifierTypeStateIssuer
21277OtherMIBLUE CROSS
1557875MedicaidMI
20277OtherMIBLUE CROSS

Other names 6

  • Henry Ford Health Providence Hospital Doing business as
  • Henry Ford Health Providence Novi Hospital Doing business as
  • Henry Ford Health Providence Southfield Hospital Doing business as
  • Henry Ford Providence Hospital Doing business as
  • Henry Ford Providence Southfield Hospital Doing business as
  • Providence-Providence Park Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070221000327 MI Part A Provider - Hospital 6103738703 Practice locations: Southfield, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003892092. Details of each certification follow.

Hospital certification: CCN 23S019

Legal name
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Doing business as
HENRY FORD HEALTH PROVIDENCE SOUTHFIELD HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
PH Family Practice32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 31

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Daniel J. Phelan Individual Corporate DirectorBoard Member Jan 1, 2022
Henry Ford Health System Organization, Troy, MI Non-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 18, 1987 100%
Charles McClure Individual Corporate DirectorBoard Member Jul 25, 2014
Robert R Lubera Individual Corporate DirectorBoard Member Sep 1, 2025
Barry G. Porter Individual Corporate DirectorBoard Member Jan 1, 2020
Steven Brian Bender Individual Corporate OfficerSecretary Oct 21, 2024
Gerardo Norcia Individual Corporate DirectorBoard Member Dec 1, 2023
Robert Riney Individual Corporate DirectorBoard Member Jul 1, 2022
Michael Rafferty Individual Corporate DirectorBoard Member Jan 1, 2020
Jeffrey Fall Individual Corporate DirectorBoard Member Sep 1, 2025
Farzan Siddiqui Individual Corporate DirectorBoard Member Jan 1, 2024
Marjorie Staten Individual Corporate OfficerAssistant Secretary Oct 21, 2024
Rhonda M Medows Individual Corporate DirectorBoard Member Sep 1, 2025
David Breen Individual Corporate DirectorBoard Member Jan 1, 2015
Mary Ann Victor Individual Corporate DirectorBoard Member Sep 1, 2025
Jason Williams Individual W-2 Managing Employee Oct 1, 2024
Anthony Rocco Tersigni Individual Corporate DirectorBoard Member Oct 1, 2024
Robin S. Damschroder Individual Corporate OfficerTreasurer Oct 1, 2024
Operational/Managerial ControlTreasurer Oct 1, 2024
Calvin R Ford Individual Corporate DirectorBoard Member Sep 1, 2025
Gregory Pflum Individual Corporate DirectorBoard Member Sep 1, 2025
Henry Ford Health Parent Organization, Detroit, MI Created for acquisition, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 80%
Ascension Michigan Organization, Troy, MI Corporation, Non-profit, Chain home office 5% Or Greater Direct Ownership Interest May 26, 2020 100%
Edward D Callaghan Individual Corporate DirectorBoard Member Sep 1, 2025
John F. Harris Individual Corporate DirectorBoard Member Jan 1, 2021
Ascension Health Organization, Saint Louis, MO Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 20%
Edgar Vann Individual Corporate DirectorBoard Member Jan 1, 2015
Lisa Fitzpatrick Individual Corporate DirectorBoard Member Sep 1, 2025
Joseph Richardson Individual Corporate DirectorBoard Member Jan 1, 2016
Gwendolyn M Mackenzie Individual Corporate DirectorBoard Member Sep 1, 2025
Jacalyn S. Goforth Individual Corporate DirectorBoard Member Jan 1, 2022
Eugene F Lovasco Individual Corporate DirectorBoard Member Oct 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 163

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 163

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784160000000",
    "number": "1003892092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-999-5829",
            "fax_number": "248-641-4840"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W. 9 MILE ROAD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "243-349-3000",
            "fax_number": "248-746-0384"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY FORD HEALTH PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-21",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A",
        "authorized_official_last_name": "DAMSCHRODER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "PRESIDENT, VAL BASED ENT &CFO",
        "authorized_official_telephone_number": "313-876-8452"
    },
    "taxonomies": [
        {
            "code": "273R00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "21277",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557875",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "20277",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Health Providence Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Health Providence Novi Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Health Providence Southfield Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Providence Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Providence Southfield Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Providence-Providence Park Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Providence-Providence Park Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.