NPIMap

Organization Active NPI

Edward W Sparrow Hospital Association

Doing business as Sparrow Medical Group Urology

  • Urology Physician
  • Lansing, MI
National Provider Identifier
1124502851
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Doing business as
Sparrow Medical Group Urology
University of Michigan Health-Sparrow Urology
Practice address
1140 E Michigan Ave Ste 300
Lansing, MI 48912-1806
Phone
(517) 364-5655
Fax
(517) 364-5655
NPI assigned
Sep 19, 2018
Last updated
Mar 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARROW HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Misty Gunter Russian
Title
Supervisor, Provider Enrollment
Phone
(517) 253-6308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

1140 E Michigan Ave Ste 300
Lansing, MI 48912-1806

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081

Other practice location 1

1200 E Michigan Ave Ste 655
Lansing, MI 48912-1837
Phone (517) 364-5655

Other practice location 2

245 S 2nd St
Carson City, MI 48811-9650
Phone (517) 364-5655

Other practice location 3

901 S Oakland St
Saint Johns, MI 48879-2200
Phone (517) 364-5655

Other names 2

  • Sparrow Medical Group Urology Doing business as
  • University of Michigan Health-Sparrow Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181106001390 MI Part B Supplier - Clinic/Group Practice 6709799166 Receives reassigned benefits from 7 practitioners
Practice locations: Saint Johns, MI; Lansing, MI; Carson City, MI

Other NPIs with the same Medicare PAC ID 19

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

View all 19

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Locations

1140 E Michigan Ave
Ste 100
Lansing, MI 48912
Phone (517) 364-9402

Practitioners & affiliated clinicians

Practitioners 7

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": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1124502851",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 E MICHIGAN AVE STE 300",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121806",
            "telephone_number": "517-364-5655",
            "fax_number": "517-364-5655"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 E Michigan Ave Ste 655",
            "address_purpose": "LOCATION",
            "city": "Lansing",
            "state": "MI",
            "postal_code": "489121837",
            "country_code": "US",
            "telephone_number": "517-364-5655",
            "fax_number": "517-364-5654",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "245 S 2nd St",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "MI",
            "postal_code": "488119650",
            "country_code": "US",
            "telephone_number": "517-364-5655",
            "fax_number": "517-364-5654",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "901 S Oakland St",
            "address_purpose": "LOCATION",
            "city": "Saint Johns",
            "state": "MI",
            "postal_code": "488792200",
            "country_code": "US",
            "telephone_number": "517-364-5655",
            "fax_number": "517-364-5654",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EDWARD W SPARROW HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2018-09-19",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "RUSSIAN",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "SUPERVISOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "517-253-6308"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sparrow Medical Group Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.