NPIMap

Organization Active NPI

Edward W Sparrow Hospital Association

Doing business as Sparrow Medical Group East Lansing

  • Family Medicine Physician
  • East Lansing, MI
National Provider Identifier
1124654793
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
EDWARD W SPARROW HOSPITAL ASSOCIATION
Doing business as
Sparrow Medical Group East Lansing
University of Michigan Health-Sparrow East Lansing Primary Care
University of Michigan Health-Sparrow Primary Care
Practice address
2900 Hannah Blvd Ste 104
East Lansing, MI 48823-5380
Phone
(517) 364-8000
Fax
(517) 364-8001
NPI assigned
Mar 16, 2020
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
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

2900 Hannah Blvd Ste 104
East Lansing, MI 48823-5380

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 253-6320

Other names 3

  • Sparrow Medical Group East Lansing Doing business as
  • University of Michigan Health-Sparrow East Lansing Primary Care Doing business as
  • University of Michigan Health-Sparrow Primary Care Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200827000629 MI Part B Supplier - Clinic/Group Practice 6709799166 Receives reassigned benefits from 8 practitioners
Practice locations: East Lansing, 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

Practitioners & affiliated clinicians

Practitioners 8

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": "1584316800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1124654793",
    "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",
            "telephone_number": "517-253-6320",
            "fax_number": "517-253-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2900 HANNAH BLVD STE 104",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235380",
            "telephone_number": "517-364-8000",
            "fax_number": "517-364-8001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD W SPARROW HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2020-03-16",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sparrow Medical Group East Lansing",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow East Lansing Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in East 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.