NPIMap

Organization Active NPI

Edward W. Sparrow Hospital Association

Doing business as SMG Williamston

  • Family Medicine Physician
  • Williamston, MI
National Provider Identifier
1205285335
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1060000091 Issued in MI
Legal business name
EDWARD W. SPARROW HOSPITAL ASSOCIATION
Doing business as
SMG Williamston
University of Michigan Health-Sparrow Williamston Primary Care
Practice address
301 Williamston Center Rd
Williamston, MI 48895-8502
Phone
(517) 253-5125
Fax
(517) 253-5126
NPI assigned
Jun 9, 2016
Last updated
Mar 26, 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 26, 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 1060000091 MI Primary

Addresses

Primary practice location

301 Williamston Center Rd
Williamston, MI 48895-8502

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 364-6253

Other names 2

  • SMG Williamston Doing business as
  • University of Michigan Health-Sparrow Williamston 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
O20160630001252 MI Part B Supplier - Clinic/Group Practice 6709799166 Receives reassigned benefits from 13 practitioners
1 other NPI on this enrollment
Practice locations: Mason, MI; Williamston, MI; Saint Johns, MI; Okemos, MI; Lansing, MI; Dewitt, MI; Holt, MI; 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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Locations

301 Williamston Center Rd
Williamston, MI 48895
Phone (517) 253-5125

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1465430400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1205285335",
    "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": "517-364-6253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 WILLIAMSTON CENTER RD",
            "city": "WILLIAMSTON",
            "state": "MI",
            "postal_code": "488958502",
            "telephone_number": "517-253-5125",
            "fax_number": "517-253-5126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD W. SPARROW HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2016-06-09",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "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": "MI",
            "license": "1060000091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG Williamston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Williamston Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Williamston, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 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.