NPIMap

Organization Active NPI

Packard Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ypsilanti, MI
National Provider Identifier
1326763079
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PACKARD HEALTH, INC.
Practice address
200 Arnet St Ste 110
Ypsilanti, MI 48198-5753
Phone
(734) 985-7200
Fax
(734) 484-0913
NPI assigned
Oct 5, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Authorized official

Name
Todd R Montrief, CPA
Title
Cfo
Phone
(734) 926-4935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

200 Arnet St Ste 110
Ypsilanti, MI 48198-5753

Mailing address

5200 Venture Dr
Ann Arbor, MI 48108-9561
Phone (734) 773-1829

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221215000645 MI Part A Provider - Federally Qualified Health Center (FQHC) 6204876113 Practice locations: Ypsilanti, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1326763079. Details of each certification follow.

Federally qualified health center certification: CCN 231189

Legal name
PACKARD HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Dec 14, 2022
Last certification
Dec 14, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
200 Arnet St
Ste 110
Ypsilanti, MI 48198-5753

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Packard Community CLN I5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jean Callum Individual Corporate OfficerCoo Feb 1, 2020
Rana Smith Individual Corporate DirectorBoard of Directors Jan 1, 2022
Edward G Snyder Individual Corporate DirectorBoard of Directors Jan 1, 2022
Paula M Lantz Individual Corporate DirectorBoard of Directors Jan 1, 2020
Raymond J Rion Individual Corporate OfficerExecutive Director Jan 1, 2016
Operational/Managerial ControlExecutive Director Jan 1, 2016
Nora Maloy Individual Corporate DirectorBoard of Directors Jan 1, 2016
Todd Montrief Individual Corporate OfficerChief Financial Officer Jan 1, 2020
Sharon Moore Individual Corporate DirectorBoard of Directors Jan 1, 2015
Deborah Vandenbroek Individual Corporate DirectorBoard of Directors Jan 1, 2022
Thomas Biggs Individual Corporate DirectorBoard of Directors Jan 1, 2015
Charles Hoffman Individual Corporate DirectorBoard of Directors Jan 1, 2016

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Packard Health IncYpsilanti, MI, CCN C71021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 12, 1989

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1664928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1326763079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VENTURE DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089561",
            "telephone_number": "734-773-1829",
            "fax_number": "734-773-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ARNET ST STE 110",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481985753",
            "telephone_number": "734-985-7200",
            "fax_number": "734-484-0913"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACKARD HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-05",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "MONTRIEF",
        "authorized_official_first_name": "TODD",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "734-926-4935",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ypsilanti, MI

Sources for this page

Verify at the official NPI Registry.