NPIMap

Organization Active NPI

Samaritan Health Care PC

  • Rural Health Clinic/Center
  • Greenville, MI
National Provider Identifier
1336865252
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
SAMARITAN HEALTH CARE PC
Practice address
811 E Kent Rd
Greenville, MI 48838-9791
Phone
(616) 225-0202
Fax
(616) 225-0207
NPI assigned
Oct 12, 2022
Last updated
Mar 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Ross Pope
Title
Ceo
Phone
(616) 502-0238

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

811 E Kent Rd
Greenville, MI 48838-9791

Mailing address

811 E Kent Rd
Greenville, MI 48838-9791

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20190104001298 MI Part B Supplier - Clinic/Group Practice 1254677719 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Rapids, MI; Greenville, MI; Muskegon, MI
O20221201000505 MI Part A Provider - Rural Health Clinic 1254677719 Practice locations: Greenville, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336865252. Details of each certification follow.

Rural health clinic certification: CCN 238940

Legal name
SAMARITAN HEALTH CARE PC
Doing business as
LIFE HEALTH CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 29, 2023
Last certification
Mar 29, 2023
Ownership / control type
1B
Organization structure
CorporationProprietary
Enrollment address
811 E Kent Rd
Greenville, MI 48838-9791

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

1465 E Apple Ave
Muskegon, MI 49442
Phone (231) 246-8092

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
Ross Pope Individual Corporate OfficerCeo Mar 18, 2026
Ethan Pope Individual Corporate DirectorDirector of Operations Sep 8, 2025
W-2 Managing EmployeeDirector of Operations Sep 8, 2025
James W. Wahl Individual 5% Or Greater Direct Ownership InterestMedical Director Mar 18, 2026 5%
Corporate DirectorMedical Director Mar 18, 2026 5%
Samaritan Management Services Organization, Grand Rapids, MI LLC, Management services company Operational/Managerial Control Oct 12, 2022
Dominic a Borgialli Individual 5% Or Greater Direct Ownership InterestOwner Mar 18, 2026 5%
Katee Elizabeth Pope Individual 5% Or Greater Direct Ownership InterestCorporate Secretary Mar 18, 2026 90%
Corporate OfficerCorporate Secretary Mar 18, 2026 90%

Owners & managing parties with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 10

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": "1665532800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1336865252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 E KENT RD",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488389791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 E KENT RD",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488389791",
            "telephone_number": "616-225-0202",
            "fax_number": "616-225-0207"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAMARITAN HEALTH CARE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-10-12",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "POPE",
        "authorized_official_first_name": "ROSS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "616-502-0238"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MI

Sources for this page

Verify at the official NPI Registry.