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Three Rivers Health System, Inc

Organization Active NPI Rural Health Clinic/Center · Three Rivers, MI

NPI 1043582224 · NPPES record last updated Sep 18, 2023

Key facts

NPI
1043582224
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Practice address
711 S Health Parkway Ste 1
Three Rivers, MI 49093-8354
Phone
(269) 273-8557
Fax
(269) 279-6461
NPI assigned
Feb 2, 2012
Organization subpart
Yes
Parent organization (as reported)
THREE RIVERS HEALTH SYSTEM, INC

Authorized official

Name
Jeffery Costello
Title
Cfo
Phone
(574) 647-3460

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 1

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

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 23

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

Other NPIs with the same Medicare PAC ID 7

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

Corporate family (same tax ID) 25

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

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

Facilities with the same owner 21

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

Practitioners 43

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

View all 43

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

Rural health clinic certification: CCN 238655

Legal name
THREE RIVERS HEALTH SYSTEM INC
Doing business as
THREE RIVERS HEALTH FAMILY, INTERNAL MEDICINE AND WOMENS SERVICES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 3, 2012
Last certification
Oct 11, 2019
Ownership / control type
2B
Organization structure
Corporation · Non-profit
Incorporated
Apr 1, 2013 in MI
Enrollment address
711 S Health Parkway
Ste 1
Three Rivers, MI 49093-8354
Related CCNs
230015

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kreg Gruber
Individual 		Corporate Officer
Ceo		 Jan 1, 2018
Irene Maffetone
Individual 		W-2 Managing Employee
Contract Specialist		 Oct 1, 2021
Beacon Health System Inc
Organization · South Bend, IN
Corporation 		Operational/Managerial Control Oct 1, 2021
Jeffrey P Costello
Individual 		Corporate Director
Cfo		 Oct 1, 2021
Operational/Managerial Control
Cfo		 Oct 1, 2021
Laurie Hines
Individual 		Corporate Director
Board Member		 Apr 1, 2013
Richard Cordes
Individual 		Corporate Director Apr 1, 2017
Linda S Evans
Individual 		Corporate Director
Board Member		 Jan 1, 2020
Hope Bailey
Individual 		Operational/Managerial Control
VP of Nursing		 Apr 1, 2013
Raymond Bendure
Individual 		Corporate Director
Board Member		 Apr 1, 2013
Jessica L Puckett
Individual 		Corporate Director Apr 1, 2017

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Three Rivers Health
Three Rivers, MI · CCN 230015		 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2013

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20140213000125 MI Part a Provider - Rural Health Clinic 8729245584 Practice locations: Three Rivers, MI
O20140729001948 MI Part B Supplier - Clinic/Group Practice 8729245584 Receives reassigned benefits from 71 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portage, MI; Three Rivers, MI; White Pigeon, MI

National Provider Directory

Tax ID family
Three Rivers Health System Inc (26 organizations share this tax ID)
Part of
Three Rivers Health System Inc

Specialties & licenses

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

Addresses

Primary practice location

711 S Health Parkway Ste 1
Three Rivers, MI 49093-8354

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers

IdentifierTypeStateIssuer
1043582224MedicaidMI

Other names

  • Three Rivers Health Family, Internal Medicine and Womens Services Doing business as

Other providers in Three Rivers, MI

All providers in Three Rivers, MI · Rural Health Clinic/Center in Michigan

Sources for this page

Verify at the official NPI Registry.