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Prime Healthcare Services-Port Huron LLC

Organization Active NPI General Acute Care Hospital · Port Huron, MI

NPI 1306227764 · NPPES record last updated Jun 11, 2015

Key facts

NPI
1306227764
Entity type
Organization (NPI type 2)
Primary specialty
General Acute Care Hospital 282N00000X
Legal business name
PRIME HEALTHCARE SERVICES-PORT HURON LLC
Practice address
2601 Electric Ave
Port Huron, MI 48060-6587
Phone
(810) 985-1500
NPI assigned
Jun 11, 2015
Organization subpart
No

Authorized official

Name
Mrs. Rebekah Smith
Title
President and Ceo
Phone
(810) 985-1500

Other NPIs with the same Medicare PAC ID 2

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

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

Facilities with the same owner 77

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

View all 77

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 56

Affiliated clinicians 233

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

View all 233

Medicare Care Compare: Hospital

Listed as
Lake Huron Medical Center CCN 230031
Overall star rating
★★★★☆ 4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
Active (Provider of Services file)
Emergency services
Yes

Source: Medicare Care Compare.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

Hospital certification: CCN 230031

Legal name
PRIME HEALTHCARE SERVICES-PORT HURON LLC
Doing business as
LAKE HURON MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1976
Last certification
Oct 25, 2013
Beds
119
Ownership / control type
Church
Most recent change of ownership
Sep 1, 2015 (2 total)
Organization structure
LLC · Proprietary
Enrollment address
2601 Electric Ave
Port Huron, MI 48060-6587
Other Hospital Practice Location
Hospital subgroups
Acute care

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Christopher Fulks
Individual 		Corporate Officer
Chief Financial Officer		 Sep 1, 2015
W-2 Managing Employee
Chief Financial Officer		 Sep 1, 2015
Prime Healthcare Services, Inc
Organization · Ontario, CA
Corporation, For-profit 		5% Or Greater Direct Ownership Interest Sep 1, 2015 100%
Steven Aleman
Individual 		Other
Corporate Chief Financial Officr		 Jun 1, 2020
Christopher Doan
Individual 		Corporate Officer
Chief Compliance Counsel		 Apr 24, 2017
Kenneth Wheeler
Individual 		Corporate Officer
VP Patient Financial Services		 Sep 1, 2015
W-2 Managing Employee
VP Patient Financial Services		 Sep 1, 2015
Prime Healthcare Holdings Inc
Organization · Ontario, CA
Holding company 		5% Or Greater Indirect Ownership Interest Sep 1, 2015 100%

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20150924000667 MI Part a Provider - Hospital 7214245208 Practice locations: Port Huron, MI
O20151123000133 MI Part B Supplier - Clinic/Group Practice 7214245208 Receives reassigned benefits from 15 practitioners
Practice locations: Port Huron, MI

National Provider Directory

Locations

48801 Romeo Plank Rd
Ste 101
Macomb, MI 48044
Phone (586) 726-8423

2601 Electric Ave
#C
Port Huron, MI 48060
Phone (810) 216-1500

Specialties & licenses

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

Addresses

Primary practice location

2601 Electric Ave
Port Huron, MI 48060-6587

Mailing address

2601 Electric Ave
Port Huron, MI 48060-6587
Phone (810) 985-1500

Other providers in Port Huron, MI

All providers in Port Huron, MI · General Acute Care Hospital in Michigan

Sources for this page

Verify at the official NPI Registry.