NPIMap

Organization Active NPI

Three Rivers Health System, Inc

Doing business as Southwest Michigan Plastic and Hand Surgery

  • Plastic Surgery Physician
  • Three Rivers, MI
National Provider Identifier
1174065767
Registry record updated Nov 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Doing business as
Southwest Michigan Plastic and Hand Surgery
Practice address
1021 Hill St
Suite 300
Three Rivers, MI 49093-2745
Phone
(269) 858-3024
Fax
(269) 273-9040
NPI assigned
Nov 14, 2016
Last updated
Nov 14, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 14, 2016

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

Authorized official

Name
William Russell
Title
Ceo/President
Phone
(269) 273-9601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery Physician 208200000X NU Primary

Addresses

Primary practice location

1021 Hill St
Suite 300
Three Rivers, MI 49093-2745

Mailing address

1021 Hill St
Suite 300
Three Rivers, MI 49093-2745
Phone (269) 858-3024

Other names 1

  • Southwest Michigan Plastic and Hand Surgery 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
Part of
Three Rivers Inc

NPI Registry JSON

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

{
    "created_epoch": "1479081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1479081600000",
    "number": "1174065767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1021 HILL ST",
            "address_2": "SUITE 300",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490932745",
            "telephone_number": "269-858-3024",
            "fax_number": "269-273-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1021 HILL ST",
            "address_2": "SUITE 300",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490932745",
            "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",
        "enumeration_date": "2016-11-14",
        "last_updated": "2016-11-14",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-273-9601"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southwest Michigan Plastic and Hand Surgery",
            "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 Nov 14, 2016; 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.