NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital

Doing business as Henry Ford Allegiance Health

  • General Acute Care Hospital
  • Jackson, MI
National Provider Identifier
1053403402
Registry record updated Jan 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL
Doing business as
Henry Ford Allegiance Health
Henry Ford Health Jackson Hospital
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-4800
Fax
(517) 205-7419
NPI assigned
Sep 29, 2006
Last updated
Jan 7, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 7, 2026

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

Authorized official

Name
Robin S. Damschroder
Title
Evp, Chief Fin & Bus Dev Officer
Phone
(313) 876-8452

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

205 N East Ave
Jackson, MI 49201-1753
Phone (517) 788-4800

Other names 2

  • Henry Ford Allegiance Health Doing business as
  • Henry Ford Health Jackson Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031215000361 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 36 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI
O20090203000500 MI Part A Provider - Hospital 0244136067

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053403402. Details of each certification follow.

Hospital certification: CCN 230092

Legal name
W. A. FOOTE MEMORIAL HOSPITAL, INC.
Doing business as
HENRY FORD HEALTH JACKSON HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Aug 3, 2011
Beds
412
Ownership / control type
Other
Organization structure
CorporationNon-profit
Enrollment address
205 N East Ave
Jackson, MI 49201-1753
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Henry Ford Allegiance HealthCCN 230092 · All quality measures
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Foote Memorial Physicia104 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 16

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 33

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 OfficerBoard Member Jan 1, 2022
Michael a. Grisdela Individual W-2 Managing EmployeeAssociate Cfo Feb 1, 2025
Henry Ford Health System Organization, Troy, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2016 100%
Charles McClure Individual Corporate DirectorBoard Member Apr 1, 2016
Robert R Lubera Individual Corporate DirectorBoard Member Sep 1, 2025
Frederiek Toney Individual Corporate DirectorBoard Member Jan 1, 2021
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 Apr 1, 2016
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 DirectorBoard Member Jan 1, 2019
Rhonda M Medows Individual Corporate DirectorBoard Member Sep 1, 2025
David Breen Individual Corporate OfficerVice Chair Apr 1, 2016
Corporate DirectorBoard Member Apr 1, 2016
Mary Ann Victor Individual Corporate DirectorBoard Member Sep 1, 2025
Jason Williams Individual W-2 Managing EmployeeVP Contracting Reimb Rev Int Oct 1, 2024
Anthony Rocco Tersigni Individual Corporate DirectorBoard Member Oct 1, 2024
Robin S. Damschroder Individual Corporate OfficerPresident, Val Based ENT &Cfo Jan 1, 2018
Calvin R Ford Individual Corporate DirectorBoard Member Jan 1, 2025
Gregory Pflum Individual Corporate DirectorBoard Member Sep 1, 2025
Henry Ford Allegiance Health Group Organization, Jackson, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2016 100%
Henry Ford Health Parent Organization, Detroit, MI Created for acquisition, Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 80%
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 Corporation, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 20%
Edgar Vann Individual Corporate DirectorBoard Member Apr 1, 2016
Lisa Fitzpatrick Individual Corporate DirectorBoard Member Sep 1, 2025
Joseph Richardson Individual Corporate DirectorBoard Member Apr 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 159

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

View all 159

Practitioners & affiliated clinicians

Practitioners 71

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 71

Affiliated clinicians 842

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 842

NPI Registry JSON

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767744000000",
    "number": "1053403402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4800",
            "fax_number": "517-796-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-4800",
            "fax_number": "517-205-7419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-29",
        "last_updated": "2026-01-07",
        "certification_date": "2026-01-07",
        "status": "A",
        "authorized_official_last_name": "DAMSCHRODER",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "EVP, CHIEF FIN & BUS DEV OFFICER",
        "authorized_official_telephone_number": "313-876-8452"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Health Jackson Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

Verify at the official NPI Registry.