NPIMap

Organization Active NPI

Wa Foote Memorial Hospital, Inc

Doing business as Henry Ford Allegiance Health

  • Emergency Medicine Physician
  • Jackson, MI
National Provider Identifier
1265487722
Registry record updated Apr 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
WA FOOTE MEMORIAL HOSPITAL, INC
Doing business as
Henry Ford Allegiance Health
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4800
NPI assigned
May 23, 2006
Last updated
Apr 1, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
WA FOOTE MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 1, 2016

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

Authorized official

Name
Jeanne' Wickens, CFO
Title
Senior Vice President of Finance
Phone
(517) 841-6979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MI
Emergency Medicine Physician 207P00000X MI Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

Department 272801
PO Box 67000
Detroit, MI 48267-2728
Phone (517) 841-7482

Other identifiers 2

IdentifierTypeStateIssuer
CC5829OtherMIRR MEDICARE
700C810330OtherMIBCBSM DOCTORS

Other names 1

  • Henry Ford Allegiance Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031215000808 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 20 practitioners
1 other NPI on this enrollment
Practice locations: Jackson, MI

Other NPIs with the same Medicare PAC ID 10

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

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
Wa Foote Memorial Hospi

Locations

1145 S Main St
Unit A
Chelsea, MI 48118
Phone (517) 205-8667

12369 E Michigan Ave
Grass Lake, MI 49240
Phone (517) 205-2525

1 S Jackson Sq
Ste 101
Jackson, MI 49201
Phone (517) 768-7766

1100 E Michigan Ave
Ste 203
Jackson, MI 49201
Phone (517) 205-3120

1100 E Michigan Ave
Ste 301
Jackson, MI 49201
Phone (517) 817-7605

1100 E Michigan Ave
Ste 310
Jackson, MI 49201
Phone (517) 788-6968

1201 E Michigan Ave
Ste 100
Jackson, MI 49201
Phone (517) 205-7224

1201 E Michigan Ave
Ste 201
Jackson, MI 49201
Phone (517) 788-4841

150 S East Ave
Jackson, MI 49201
Phone (517) 205-2146

205 N East Ave
#4
Jackson, MI 49201

205 N East Ave
#5
Jackson, MI 49201

205 N West Ave
Jackson, MI 49201

2424 W Washington Ave
Jackson, MI 49203
Phone (517) 205-2732

3235 E Michigan Ave
Unit 100
Jackson, MI 49202

3333 Spring Arbor Rd
Ste 100200
Jackson, MI 49203

704 E Michigan Ave
Jackson, MI 49201
Phone (517) 205-7683

815 W Michigan Ave
Jackson, MI 49202

810 Hogsback Rd
Mason, MI 48854
Phone (517) 205-1653

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 327

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 327

NPI Registry JSON

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

{
    "created_epoch": "1148342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459468800000",
    "number": "1265487722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPARTMENT 272801",
            "address_2": "PO BOX 67000",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672728",
            "telephone_number": "517-841-7482",
            "fax_number": "517-841-7476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2006-05-23",
        "last_updated": "2016-04-01",
        "status": "A",
        "authorized_official_last_name": "WICKENS",
        "authorized_official_first_name": "JEANNE'",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "517-841-6979",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC5829",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM DOCTORS",
            "identifier": "700C810330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.