NPIMap

Organization Active NPI

Prime Healthcare Services-Port Huron LLC

  • General Acute Care Hospital
  • Port Huron, MI
National Provider Identifier
1306227764
Registry record updated Jun 11, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 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
Last updated
Jun 11, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2015

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

Authorized official

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

Specialties & licenses 1

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

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

Medicare participation

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

Enrollment records 2

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306227764. Details of each certification follow.

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
LLCProprietary
Enrollment address
2601 Electric Ave
Port Huron, MI 48060-6587
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Lake Huron Medical CenterCCN 230031 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

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

Ownership & related parties

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 OfficerChief Financial Officer Sep 1, 2015
W-2 Managing EmployeeChief 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 OtherCorporate Chief Financial Officr Jun 1, 2020
Christopher Doan Individual Corporate OfficerChief Compliance Counsel Apr 24, 2017
Kenneth Wheeler Individual Corporate OfficerVP Patient Financial Services Sep 1, 2015
W-2 Managing EmployeeVP 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%

Facilities with the same owner 77

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

View all 77

Practitioners & affiliated clinicians

Practitioners 56

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 56

Affiliated clinicians 233

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

View all 233

NPI Registry JSON

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

{
    "created_epoch": "1433980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433980800000",
    "number": "1306227764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-985-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-985-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME HEALTHCARE SERVICES-PORT HURON LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-11",
        "last_updated": "2015-06-11",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "REBEKAH",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "810-985-1500",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

Verify at the official NPI Registry.