NPIMap

Organization Active NPI

Sparrow Carson Hospital

Doing business as University of Michigan Health-Sparrow

  • Rural Health Clinic/Center
  • Carson City, MI
National Provider Identifier
1013987833
Registry record updated Apr 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SPARROW CARSON HOSPITAL
Doing business as
University of Michigan Health-Sparrow
Practice address
102 S. Third St
Suite 100
Carson City, MI 48811
Phone
(989) 584-1308
Fax
(989) 584-0307
NPI assigned
Jan 24, 2006
Last updated
Apr 5, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARROW HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 5, 2024

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

Authorized official

Name
Misty Gunter Russian
Title
Supervisor, Provider Enrollment
Phone
(517) 253-6308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

102 S. Third St
Suite 100
Carson City, MI 48811

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (989) 584-3131

Other names 2

  • University of Michigan Health-Sparrow Doing business as
  • University of Michigan Health-Sparrow Carson Primary Care Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040126000046 MI Part B Supplier - Clinic/Group Practice 7113836701 Receives reassigned benefits from 241 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Greenville, MI; Stanton, MI; Mount Pleasant, MI; Ithaca, MI; Fowler, MI; Carson City, MI
O20071025000646 MI Part A Provider - Rural Health Clinic 7113836701 Practice locations: Carson City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013987833. Details of each certification follow.

Rural health clinic certification: CCN 233994

Legal name
SPARROW CARSON HOSPITAL
Doing business as
UNIVERSITY OF MICHIGAN HEALTH-SPARROW CARSON PRIMARY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 1997
Last certification
Dec 21, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
102 S 3Rd St
Ste 100
Carson City, MI 48811-5115
Related CCNs
230208

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

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 19

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 19

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Member of 1

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

Locations

423 E Main St
Ste B
Carson City, MI 48811
Phone (989) 584-6320

550 E Washington St
Ionia, MI 48846
Phone (616) 523-1600

545 N State St
Stanton, MI 48888
Phone (989) 584-3131

817 E 6th St
Tishomingo, OK 73460
Phone (580) 371-2392

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Matthew D Wilcox Individual Corporate OfficerBoard Member Jul 1, 2025
Eric J Strucko Individual Corporate OfficerBoard Member / Treasurer Jul 1, 2025
Laura M Gibson Individual Corporate OfficerBoard Member Jul 1, 2025
Candace S Metcalf Individual Corporate OfficerBoard Member Jul 1, 2025
Harper T Wildern Individual Corporate OfficerBoard Member / Board Chair Jul 1, 2025
Margaret a Dimond Individual Corporate OfficerPresident, Um Health Regional Netwk Jan 1, 2024
W-2 Managing EmployeePresident, Um Health Regional Netwk Jan 1, 2024
Misty Gunter Russian Individual W-2 Managing EmployeeSupervisor, Provider Enrollment Jan 1, 2024
Daniel Balice Individual Corporate OfficerBoard Member Jul 1, 2025
Carol Priebe Wiles Individual Corporate OfficerBoard Member Jul 1, 2025
Sparrow Health System Organization, Lansing, MI Corporation, Non-profit, Chain home office, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2015 100%
John Milewski Individual Corporate OfficerBoard Member Jul 1, 2025
Gregory a Holzhei Individual Corporate OfficerBoard Member/ Secretary Jul 1, 2025
John Hendrickson Individual Corporate OfficerBoard Member/ Vice Chair Jul 1, 2025
Bruce a Courtade Individual Corporate OfficerBoard Member Jul 1, 2025
Anthony Mazzali Individual Corporate OfficerBoard Member Jul 1, 2025
Timothy L Williams Individual Corporate OfficerBoard Member Jul 1, 2025
Lakeeya K Tucker Individual Corporate OfficerBoard Member Jul 1, 2025

Owners & managing parties with NPI records 4

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

Facilities with the same owner 16

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

View all 16

Practitioners & affiliated clinicians

Practitioners 95

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 95

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712275200000",
    "number": "1013987833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860081",
            "telephone_number": "989-584-3131",
            "fax_number": "989-584-6734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 S. THIRD ST",
            "address_2": "SUITE 100",
            "city": "CARSON CITY",
            "state": "MI",
            "postal_code": "48811",
            "telephone_number": "989-584-1308",
            "fax_number": "989-584-0307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARROW CARSON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2006-01-24",
        "last_updated": "2024-04-05",
        "certification_date": "2024-04-05",
        "status": "A",
        "authorized_official_last_name": "RUSSIAN",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "SUPERVISOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "517-253-6308"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "University of Michigan Health-Sparrow",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Carson Primary Care",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carson City, MI

Sources for this page

Verify at the official NPI Registry.