NPIMap

Organization Active NPI

Sparrow Eaton Hospital

Doing business as UM Health-Sparrow Charlotte General Surgery

  • Surgery Physician
  • Charlotte, MI
National Provider Identifier
1336313022
Registry record updated Mar 18, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301054410 Issued in MI
Legal business name
SPARROW EATON HOSPITAL
Doing business as
UM Health-Sparrow Charlotte General Surgery
Practice address
111 Lansing St
Suite 220
Charlotte, MI 48813-2400
Phone
(517) 543-9564
Fax
(517) 541-1668
NPI assigned
Apr 15, 2008
Last updated
Mar 18, 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 18, 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
Surgery Physician 208600000X 4301054410 MI Primary

Addresses

Primary practice location

111 Lansing St
Suite 220
Charlotte, MI 48813-2400

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 253-6320

Other practice location 1

321 E Harris St
Charlotte, MI 48813-1629
Phone (517) 543-9564

Other names 2

  • UM Health-Sparrow Charlotte General Surgery Doing business as
  • Hayes Green Beach Memorial Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080714000331 MI Part B Supplier - Clinic/Group Practice 0042103509 Receives reassigned benefits from 10 practitioners
Practice locations: Charlotte, MI

Other NPIs with the same Medicare PAC ID 3

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

National Provider Directory

National Provider Directory
Tax ID family
Hayes Green Beach Hosp15 organizations share this tax ID, including this one
Part of
Sparrow Health System

Other organizations with this tax ID 14

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

View all 14

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

330 W Lake Lansing Rd
Ste 4
East Lansing, MI 48823

Practitioners & affiliated clinicians

Practitioners 11

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": "1208217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710720000000",
    "number": "1336313022",
    "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": "517-253-6320",
            "fax_number": "517-253-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 LANSING ST",
            "address_2": "SUITE 220",
            "city": "CHARLOTTE",
            "state": "MI",
            "postal_code": "488132400",
            "telephone_number": "517-543-9564",
            "fax_number": "517-541-1668"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "321 E Harris St",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "MI",
            "postal_code": "488131629",
            "country_code": "US",
            "telephone_number": "517-543-9564",
            "fax_number": "517-541-1668",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPARROW EATON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2008-04-15",
        "last_updated": "2024-03-18",
        "certification_date": "2024-03-18",
        "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": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301054410",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UM Health-Sparrow Charlotte General Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Hayes Green Beach Memorial Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Charlotte, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 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.