Active NPI
Wa Foote Memorial Hospital, Inc
- Nurse Practitioner
- Jackson, MI
National Provider Identifier
1124052279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- Legal business name
- WA FOOTE MEMORIAL HOSPITAL, INC
- Practice address
- 205 N East Ave
Jackson, MI 49201-1753 - Phone
- (517) 788-4800
- NPI assigned
- Jul 11, 2006
- Organization subpart
- Yes
- Parent organization
- WA FOOTE MEMORIAL HOSPITAL, INC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mark Smith, CFO
- Title
- SVP, Cmo
- Phone
- (517) 205-6407
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | MI | ||
| Nurse Practitioner | 363L00000X | Primary | ||
| Advanced Practice Midwife | 367A00000X |
Addresses
Primary practice location
205 N East Ave
Jackson, MI 49201-1753
Mailing address
PO Box 67000
Department 272801
Detroit, MI 48267-2728
Phone (517) 841-7482
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CC5829 | Other | MI | RR MEDICARE |
| 500C810310 | Other | MI | BCBSM/CNP |
Other names 1
- Henry Ford Allegiance Health
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040612000395 | MI | Part B Supplier - Clinic/Group Practice | 0244136067 |
Receives reassigned benefits from 348 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Jackson, MI; Jonesville, MI; Leslie, MI; Mason, MI; Michigan Center, MI; Onsted, MI; Spring Arbor, MI; Marshall, MI… |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Endocrinology, Diabetes & Metabolism Physician
- Jackson, MI
- NPI 1790222651
O20040612000395
-
- Internal Medicine Physician
- Jackson, MI
- NPI 1083971477
O20040612000395
National Provider Directory
National Provider Directory- Part of
- Foote Emerg Phys
Ownership & related parties
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.
-
- General Acute Care Hospital
- Jackson, MI
- NPI 1285786434
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Nurse Practitioner
- Ann Arbor, MI
- NPI 1780949248
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152576000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709683200000",
"number": "1124052279",
"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": "482672728",
"telephone_number": "517-841-7482",
"fax_number": "517-841-7476"
},
{
"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": "517-788-4800"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
"enumeration_date": "2006-07-11",
"last_updated": "2024-03-06",
"certification_date": "2024-03-06",
"status": "A",
"authorized_official_last_name": "SMITH",
"authorized_official_first_name": "MARK",
"authorized_official_title_or_position": "SVP, CMO",
"authorized_official_telephone_number": "517-205-6407",
"authorized_official_credential": "CFO"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "MI",
"license": null,
"primary": false
},
{
"code": "363L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner",
"state": null,
"license": null,
"primary": true
},
{
"code": "367A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Advanced Practice Midwife",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "CC5829",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM/CNP",
"identifier": "500C810310",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Henry Ford Allegiance Health",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Jackson, MI
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
- Wa Foote Memorial Hospital, Inc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; 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.