NPIMap

Organization Active NPI

Sparrow Clinton Hospital

Doing business as SMG St Johns

  • Multi-Specialty Clinic/Center
  • Saint Johns, MI
National Provider Identifier
1306893078
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
SPARROW CLINTON HOSPITAL
Doing business as
SMG St Johns
University of Michigan Health-Sparrow St. Johns Primary Care
Practice address
901 S Oakland St
Saint Johns, MI 48879-2200
Phone
(989) 224-2338
Fax
(989) 224-2065
NPI assigned
May 28, 2006
Last updated
Mar 11, 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 11, 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
Multi-Specialty Clinic/Center 261QM1300X MI Primary

Addresses

Primary practice location

901 S Oakland St
Saint Johns, MI 48879-2200

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 364-6287

Other identifiers 2

IdentifierTypeStateIssuer
1306893078MedicaidMI
70-0-A9-1002-0OtherMIBCBS

Other names 2

  • SMG St Johns Doing business as
  • University of Michigan Health-Sparrow St. Johns Primary Care Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031111000063 MI Part B Supplier - Clinic/Group Practice 5395658850 Receives reassigned benefits from 131 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Johns, MI; St Johns, MI
O20040301000072 MI Part B Supplier - Clinic/Group Practice 5395658850 Receives reassigned benefits from 127 practitioners
3 other NPIs on this enrollment
Practice locations: Saint Johns, MI; St. Johns, MI; Owosso, MI; Ionia, MI; Lansing, MI; Charlotte, MI; Dewitt, MI; East Lansing, MI

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 5

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

1457 N M 52
Ste 1
Owosso, MI 48867
Phone (989) 725-8436

1457 N M 52
Ste 200
Owosso, MI 48867
Phone (989) 224-2338

1002 N US Highway 27
Saint Johns, MI 48879
Phone (989) 224-1452

805 S Oakland St
#3
Saint Johns, MI 48879
Phone (989) 227-3345

901 S Oakland St
Ste 103
Saint Johns, MI 48879
Phone (989) 224-8971

901 S Oakland St
Ste 201
Saint Johns, MI 48879
Phone (989) 224-2338

Practitioners & affiliated clinicians

Practitioners 239

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 239

NPI Registry JSON

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

{
    "created_epoch": "1148774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1306893078",
    "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": "517-364-6287",
            "fax_number": "517-364-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 S OAKLAND ST",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488792200",
            "telephone_number": "989-224-2338",
            "fax_number": "989-224-2065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARROW CLINTON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2006-05-28",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "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": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1306893078",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "70-0-A9-1002-0",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SMG St Johns",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SMG St Johns",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow St. Johns Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.