NPIMap

Organization Active NPI

Three Rivers Health System, Inc

Doing business as Three Rivers Health Orthopedics

  • Orthopaedic Surgery Physician
  • Three Rivers, MI
National Provider Identifier
1124390307
Registry record updated Jul 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Doing business as
Three Rivers Health Orthopedics
Practice address
1021 Hill St Ste 300
Three Rivers, MI 49093-2744
Phone
(269) 858-3024
Fax
(269) 273-9040
NPI assigned
Feb 2, 2012
Last updated
Jul 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTH SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 22, 2024

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

Authorized official

Name
Jeffery Costello
Title
Cfo / Chief Financial Officer
Phone
(574) 647-3460

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X NU Primary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X NU

Addresses

Primary practice location

1021 Hill St Ste 300
Three Rivers, MI 49093-2744

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
1124390307MedicaidMI

Other names 1

  • Three Rivers Health Orthopedics Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Inc26 organizations share this tax ID, including this one
Part of
Three Rivers Inc

Other organizations with this tax ID 25

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

View all 25

Locations

7971 Moorsbridge Rd
Portage, MI 49024
Phone (269) 321-0929

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.

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1328140800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721606400000",
    "number": "1124390307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 HILL ST STE 300",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490932744",
            "telephone_number": "269-858-3024",
            "fax_number": "269-273-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HEALTH SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS HEALTH SYSTEM, INC",
        "enumeration_date": "2012-02-02",
        "last_updated": "2024-07-22",
        "certification_date": "2024-07-22",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CFO / CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "574-647-3460"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124390307",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Orthopedics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Three Rivers, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.

Verify at the official NPI Registry.