NPIMap

Organization Active NPI

Botsford General Hospital

  • Family Medicine Physician
  • Dearborn Heights, MI
National Provider Identifier
1114935566
Registry record updated May 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BOTSFORD GENERAL HOSPITAL
Practice address
27031 W Warren St
Dearborn Heights, MI 48127-1901
Phone
(313) 274-3320
Fax
(313) 730-9222
NPI assigned
Aug 3, 2006
Organization subpart
Yes
Parent organization
BOTSFORD GENERAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 16, 2023

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

Authorized official

Name
Nancy Susick
Title
Chief Operating Officer
Phone
(947) 522-3338

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

27031 W Warren St
Dearborn Heights, MI 48127-1901

Mailing address

26901 Beaumont Blvd Ste 3D
Southfield, MI 48033-3849

Other identifiers 1

IdentifierTypeStateIssuer
160F371160OtherMIBLUE CROSS

Other names 1

  • Botsford Primary Care Physicians Other name

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031112000329 MI Part B Supplier - Clinic/Group Practice 2668385238 Receives reassigned benefits from 10 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington, MI; Farmington Hills, MI
O20071121000589 MI Part A Provider - Hospital 2668385238 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Farmington Hills, MI; Livonia, MI; Troy, MI; Sterling Heights, MI; Redford, MI; Dearborn Heights, MI

Hospital certification: CCN 230151

Legal name
BOTSFORD GENERAL HOSPITAL
Doing business as
COREWELL HEALTH FARMINGTON HILLS HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 22, 2010
Beds
305
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
28050 Grand River Ave
Farmington Hills, MI 48336-5919
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 10

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Beaumont Hospital - Farmington HillsCCN 230151
Overall star rating
3 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
ER Phys-Botsford Gen Ho

Locations

27031 W Warren St
Dearborn Heights, MI 48127
Phone (313) 274-3320

Ownership & related parties

All disclosed owners & managing parties 19

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

NameRoleSinceShare
Whitney Eckhoff Individual W-2 Managing EmployeeManager,, Provider Enrollment Oct 1, 2023
Debra Guido-Allen Individual Operational/Managerial ControlHospital President Jul 1, 2026 100%
Barbara J Pilarski Individual Corporate DirectorBoard Member Jan 1, 2024
Marija J Grahovac Individual Corporate DirectorBoard Member Jan 1, 2025
Chad M Tuttle Individual Corporate DirectorBoard Member Jan 1, 2026
Operational/Managerial ControlChief Operating Officer, CH May 1, 2025 100%
Mary Kosch Individual Corporate DirectorBoard Member Jan 1, 2026
Mona Makki Individual Corporate DirectorBoard Member Jan 1, 2023
Beaumont Health Organization, Southfield, MI Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 1, 2014 100%
Matthew E Cox Individual Corporate OfficerChief Financial Officer Feb 1, 2022
Corewell Health Organization, Grand Rapids, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Feb 1, 2022 100%
Operational/Managerial Control Feb 1, 2022 100%
Lamont Yoder Individual Corporate DirectorBoard Member Jan 1, 2026
Operational/Managerial ControlPresident, Corewell Health East May 1, 2025 100%
Robert James Welsh Individual Corporate DirectorBoard Member Jan 1, 2021
Warren E Rose Individual Corporate DirectorBoard Member Jan 1, 2022
Mark D Davidoff Individual Corporate DirectorBoard Member Jan 1, 2026
Nicholas P Gates Individual Corporate DirectorBoard Member Jan 1, 2026
Faye a Nelson Individual Corporate DirectorBoard Member Jun 16, 2022
Shane O'Donnell Individual Corporate DirectorBoard Member Jan 1, 2024
Anthony Stallion Individual Corporate DirectorBoard Member Feb 1, 2022
Linda Little Individual Corporate DirectorBoard Member Jun 16, 2022

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Affiliated clinicians 1,266

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

View all 1,266

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1684195200000",
    "number": "1114935566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26901 BEAUMONT BLVD STE 3D",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480333849"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27031 W WARREN ST",
            "city": "DEARBORN HEIGHTS",
            "state": "MI",
            "postal_code": "481271901",
            "telephone_number": "313-274-3320",
            "fax_number": "313-730-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOTSFORD GENERAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BOTSFORD GENERAL HOSPITAL",
        "enumeration_date": "2006-08-03",
        "last_updated": "2023-05-16",
        "certification_date": "2023-05-16",
        "status": "A",
        "authorized_official_last_name": "SUSICK",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CHIEF OPERATING OFFICER",
        "authorized_official_telephone_number": "947-522-3338"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "160F371160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Botsford Primary Care Physicians",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Botsford Primary Care Physicians",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Dearborn Heights, MI

Sources for this page

Verify at the official NPI Registry.