NPIMap

Edward W Sparrow Hospital Association

Organization Active NPI Internal Medicine Physician · Lansing, MI

NPI 1043562465 · NPPES record last updated Mar 18, 2024

Key facts

NPI
1043562465
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Practice address
1200 E Michigan Ave
Suite 500
Lansing, MI 48912-1800
Phone
(517) 364-5123
Fax
(517) 364-5124
NPI assigned
Oct 9, 2012
Organization subpart
Yes
Parent organization (as reported)
SPARROW HEALTH SYSTEM

Authorized official

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

Other NPIs with the same Medicare PAC ID 19

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

Practitioners 705

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 705

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20130503000582 MI Part B Supplier - Clinic/Group Practice 6709799166 Receives reassigned benefits from 20 practitioners
Practice locations: Lansing, MI

National Provider Directory

Part of
Sparrow Health System

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes
Nurse Practitioner
Group: 193200000X MULTI-SPECIALTY GROUP		 363L00000X

Addresses

Primary practice location

1200 E Michigan Ave
Suite 500
Lansing, MI 48912-1800

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 253-6320

Other names

  • SMG Lansing Internal Medicine Doing business as
  • University of Michigan Health-Sparrow Lansing Internal Medicine Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 18, 2024.

{
    "created_epoch": "1349740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1043562465",
    "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": "517-253-6320",
            "fax_number": "517-364-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE",
            "address_2": "SUITE 500",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121800",
            "telephone_number": "517-364-5123",
            "fax_number": "517-364-5124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD W SPARROW HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2012-10-09",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG Lansing Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Lansing Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lansing, MI

All providers in Lansing, MI · Internal Medicine Physician in Michigan

Sources for this page

Verify at the official NPI Registry.