NPIMap

Organization Active NPI

Henry Ford Health Providence Hospital

  • General Acute Care Hospital
  • Novi, MI
National Provider Identifier
1144210253
Registry record updated Apr 28, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Practice address
47601 Grand River Ave
Novi, MI 48374-1233
Phone
(248) 465-4170
NPI assigned
Oct 28, 2005
Last updated
Apr 28, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2026

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

Authorized official

Name
Kimberly Cebalt
Title
Director of Provider Affairs
Phone
(313) 874-6764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

47601 Grand River Ave
Novi, MI 48374-1233

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (248) 641-4041

Other practice location 1

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 746-5896

Other identifiers 9

IdentifierTypeStateIssuer
118635OtherGREAT LAKES
00277OtherBLUE CROSS
M004776OtherTRICARE
100082OtherCARE CHOICE
1015800008OtherBOTSFORD
00000001504AOtherCAPE
0061570OtherAETNA
934000OtherBEAUMONT
HL630006OtherMCARE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070220000679 MI Part A Provider - Hospital 6103738703

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144210253. Details of each certification follow.

Hospital certification: CCN 230019

Legal name
HENRY FORD HEALTH PROVIDENCE HOSPITAL
Doing business as
HENRY FORD HEALTH PROVIDENCE SOUTHFIELD HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 31, 2004
Beds
434
Ownership / control type
Church
Organization structure
CorporationNon-profit
Enrollment address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Main/Primary Hospital Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Ascension Providence Hospital, Southfield and NoviCCN 230019 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Ascension Hospital32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

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

View all 31

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations (25 of 63)

43800 Garfield Rd
Ste 211
Clinton Twp, MI 48038

23874 Kean St
Ste 100
Dearborn, MI 48124
Phone (248) 865-9898

1050 Corp Ofc Dr
Ste 100
Detroit, MI 48267

22101 Moross Rd
Ste 590
Detroit, MI 48236

22101 Moross Rd
Ste B136
Detroit, MI 48236

4160 John R St
Ste 608
Detroit, MI 48201
Phone (248) 455-0865

30055 Northwestern Hwy
Ste 220
Farmington Hills, MI 48334
Phone (248) 380-6624

30055 Northwestern Hwy
Ste 235
Farmington Hills, MI 48334
Phone (248) 737-4600

30055 Northwestern Hwy
Ste L
Farmington Hills, MI 48334

33742 W 12 Mile Rd
Farmington Hills, MI 48331
Phone (248) 449-1655

37000 Grand River Ave
Ste 310
Farmington Hills, MI 48335
Phone (913) 223-0811

221 W Troy St
Ste 400
Ferndale, MI 48220
Phone (248) 844-6100

2020 Middlebelt Rd
Ste C
Garden City, MI 48135
Phone (248) 465-3910

22151 Moross Rd
Ste 400
Grosse Pointe, MI 48236

22201 Moross Rd
Ste A218
Grosse Pointe, MI 48236

19229 Mack Ave
Ste 230
Grosse Pointe Woods, MI 48236

19229 Mack Ave
Ste 705
Grosse Pointe Woods, MI 48236

1125 S Latson Rd Ste 300
Howell, MI 48843

1200 Byron Rd
Howell, MI 48843
Phone (517) 546-0200

1225 S Latson Rd
Howell, MI 48843
Phone (248) 662-4300

1225 S Latson Rd
#380
Howell, MI 48843

1225 S Latson Rd
Ste 230
Howell, MI 48843
Phone (517) 548-7777

1225 S Latson Rd
Ste 260
Howell, MI 48843
Phone (517) 541-4444

1225 S Latson Rd
Ste 300
Howell, MI 48843
Phone (248) 465-4847

1225 S Latson Rd
Ste 530
Howell, MI 48843

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Daniel J. Phelan Individual Corporate DirectorBoard Member Jan 1, 2022
Henry Ford Health System Organization, Troy, MI Non-profit, Chain home office, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Dec 18, 1987 100%
Charles McClure Individual Corporate DirectorBoard Member Jul 25, 2014
Robert R Lubera Individual Corporate DirectorBoard Member Jan 1, 2025
Barry G. Porter Individual Corporate DirectorBoard Member Jan 1, 2020
Steven Brian Bender Individual Corporate OfficerSecretary Oct 21, 2024
Gerardo Norcia Individual Corporate DirectorBoard Member Dec 1, 2023
Robert Riney Individual Corporate DirectorBoard Member Jul 1, 2022
Michael Rafferty Individual Corporate DirectorBoard Member Jan 1, 2020
Jeffrey Fall Individual Corporate DirectorBoard Member Jan 1, 2025
Farzan Siddiqui Individual Corporate DirectorBoard Member Jan 1, 2024
Marjorie Staten Individual Corporate OfficerAssistant Secretary Oct 21, 2024
Rhonda M Medows Individual Corporate DirectorBoard Member Jan 1, 2025
David Breen Individual Corporate DirectorBoard Member Jan 1, 2015
Mary Ann Victor Individual Corporate DirectorBoard Member Sep 1, 2025
Jason Williams Individual W-2 Managing Employee Oct 1, 2024
Anthony Rocco Tersigni Individual Corporate DirectorBoard Member Oct 1, 2024
Robin S. Damschroder Individual Corporate OfficerTreasurer Oct 1, 2024
Operational/Managerial ControlTreasurer Oct 1, 2024
Calvin R Ford Individual Corporate DirectorBoard Member Jan 1, 2025
Gregory Pflum Individual Corporate DirectorBoard Member Sep 1, 2025
Henry Ford Health Parent Organization, Detroit, MI Created for acquisition, Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 80%
Ascension Michigan Organization, Warren, MI Non-profit, Chain home office 5% Or Greater Direct Ownership Interest May 26, 2020 100%
Edward D Callaghan Individual Corporate DirectorBoard Member Jan 1, 2025
John F. Harris Individual Corporate DirectorBoard Member Jan 1, 2021
Ascension Health Organization, Saint Louis, MO Non-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2024 20%
Edgar Vann Individual Corporate DirectorBoard Member Jan 1, 2015
Lisa Fitzpatrick Individual Corporate DirectorBoard Member Jan 1, 2025
Joseph Richardson Individual Corporate DirectorBoard Member Jan 1, 2016
Gwendolyn M Mackenzie Individual Corporate DirectorBoard Member Jan 1, 2025
Jacalyn S. Goforth Individual Corporate DirectorBoard Member Jan 1, 2022
Eugene F Lovasco Individual Corporate DirectorBoard Member Oct 1, 2024

Owners & managing parties with NPI records 2

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

Facilities with the same owner 163

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 163

Practitioners & affiliated clinicians

Practitioners 445

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.

View all 445

Affiliated clinicians 1,116

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

View all 1,116

NPI Registry JSON

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

{
    "created_epoch": "1130457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1777334400000",
    "number": "1144210253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "248-641-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47601 GRAND RIVER AVE",
            "city": "NOVI",
            "state": "MI",
            "postal_code": "483741233",
            "telephone_number": "248-465-4170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "16001 W 9 Mile Rd",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480754818",
            "country_code": "US",
            "telephone_number": "248-746-5896",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HENRY FORD HEALTH PROVIDENCE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-28",
        "last_updated": "2026-04-28",
        "certification_date": "2026-04-28",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER AFFAIRS",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GREAT LAKES",
            "identifier": "118635",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00277",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "M004776",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICE",
            "identifier": "100082",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOTSFORD",
            "identifier": "1015800008",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAPE",
            "identifier": "00000001504A",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0061570",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEAUMONT",
            "identifier": "934000",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCARE",
            "identifier": "HL630006",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Novi, MI

Sources for this page

Verify at the official NPI Registry.