NPIMap

Organization Active NPI

State of Michigan Office of Financial Management

Doing business as Kalamazoo Psychiatric Hospital

  • Psychiatric Hospital
  • Kalamazoo, MI
National Provider Identifier
1194736587
Registry record updated Oct 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Doing business as
Kalamazoo Psychiatric Hospital
Practice address
1312 Oakland Dr
Kalamazoo, MI 49008-1205
Phone
(269) 337-3106
Fax
(269) 337-3121
NPI assigned
Aug 10, 2006
Last updated
Oct 25, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2022

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

Authorized official

Name
Gordy Norris
Title
Administrative Manager
Phone
(269) 337-3048

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

1312 Oakland Dr
Kalamazoo, MI 49008-1205

Mailing address

1312 Oakland Dr
Kalamazoo, MI 49008-1205
Phone (269) 337-3106

Other names 1

  • Kalamazoo Psychiatric Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040114000603 MI Part B Supplier - Clinic/Group Practice 5496650723 Receives reassigned benefits from 101 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kalamazoo, MI; Westland, MI; Marquette, MI; Caro, MI
O20040805000118 MI Part A Provider - Hospital 5496650723 Practice locations: Kalamazoo, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194736587. Details of each certification follow.

Hospital certification: CCN 234026

Legal name
STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT
Doing business as
KALAMAZOO PSYCHIATRIC HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jun 17, 1988
Last certification
Oct 27, 2010
Beds
210
Ownership / control type
State
Organization structure
GovernmentNon-profit
Enrollment address
1312 Oakland Dr
Kalamazoo, MI 48009-1205
Other Hospital Practice Location
Hospital subgroups
General

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 4

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Kalamazoo Regional Psychiatric HospitalCCN 234026 · All quality measures
Type
Psychiatric
Ownership
Government - State
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0897601Kalamazoo Regional Psychiatric Hospital1312 Oakland Drive, Kalamazoo, MI 49008Certificate of waiverFeb 8, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gross S15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Locations

1312 Oakland Dr
#A
Kalamazoo, MI 49008
Phone (616) 337-3413

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Gordon Norris Individual Operational/Managerial Control Jul 5, 2016
State of Michigan Office of Financial Management Organization, Kalamazoo, MI 5% Or Greater Direct Ownership Interest Jan 1, 1966 100%
5% Or Greater Security Interest Jan 1, 1966 100%
Operational/Managerial Control May 6, 2015 100%

Owners & managing parties with NPI records 7

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

All facility ownership & control disclosures 6

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Walter P Reuther Psychiatric HospitalWestland, MI, CCN 234035 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Nov 17, 1992
Dec 2, 2015
Caro Psychiatric HospitalCaro, MI, CCN 234025 Hospital 5% Or Greater Direct Ownership Interest (100%)
5% Or Greater Security Interest (100%)
Operational/Managerial Control (100%)		 Jun 14, 1966
Jun 14, 1966
May 6, 2015
Center for Forensic PsychiatrySaline, MI, CCN 234041 Hospital 5% Or Greater Direct Ownership Interest (100%) Aug 6, 1975
DJ Jacobetti Home for VeteransMarquette, MI, CCN 235724 Skilled nursing facility Operational/Managerial Control (100%)
Adp of the SNF		 Jan 1, 1981
Jan 1, 1981
Department of Military & Veteran AffairsChesterfield, MI, CCN 235728 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Mar 1, 2019
Mar 1, 2019
Department of Military & Veteran AffairsGrand Rapids, MI, CCN 235729 Skilled nursing facility Operational/Managerial Control (100%)
Adp of the SNF		 May 17, 2021
Jan 1, 1885

Owned or controlled facilities with NPI records 7

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 6

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

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666656000000",
    "number": "1194736587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1312 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081205",
            "telephone_number": "269-337-3106",
            "fax_number": "269-337-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1312 OAKLAND DR",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490081205",
            "telephone_number": "269-337-3106",
            "fax_number": "269-337-3121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF MICHIGAN OFFICE OF FINANCIAL MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A",
        "authorized_official_last_name": "NORRIS",
        "authorized_official_first_name": "GORDY",
        "authorized_official_title_or_position": "ADMINISTRATIVE MANAGER",
        "authorized_official_telephone_number": "269-337-3048"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kalamazoo Psychiatric Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.