NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital, Inc

  • Audiologist
  • Jackson, MI
National Provider Identifier
1053858910
Registry record updated Mar 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
1060000044 Issued in MI
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL, INC
Practice address
205 N. East Ave
Jackson, MI 49201
Phone
(517) 841-7843
Fax
(517) 841-7419
NPI assigned
Jan 30, 2017
Organization subpart
Yes
Parent organization
HENRY FORD ALLEGIANCE HEALTH GROUPAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 2, 2017

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

Authorized official

Name
Kevin Leonard
Title
VP Finance
Phone
(517) 841-7843

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193200000X MULTI-SPECIALTY GROUP 231H00000X 1060000044 MI Primary

Addresses

Primary practice location

205 N. East Ave
Jackson, MI 49201

Mailing address

PO Box 67000
Department 272801
Detroit, MI 48267
Phone (517) 841-7843

Other identifiers 1

IdentifierTypeStateIssuer
1811921968MedicaidMI

Other names 1

  • Henry Ford Allegiance Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001606 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Foote Emerg Phys104 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 17

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

View all 17

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488412800000",
    "number": "1053858910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48267",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        },
        {
            "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": "49201",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENRY FORD ALLEGIANCE HEALTH GROUP",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-03-02",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "517-841-7843"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "MI",
            "license": "1060000044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1811921968",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.