NPIMap

Organization Active NPI

Prime Healthcare Services-Port Huron LLC

  • Rehabilitation Hospital Unit
  • Port Huron, MI
National Provider Identifier
1356723027
Registry record updated Jun 18, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Hospital UnitTaxonomy code 273Y00000X
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 18, 2015
Last updated
Jun 18, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2015

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

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital Unit 273Y00000X 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 MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150924002337 MI Part A Provider - Hospital 7214245208 Practice locations: Port Huron, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356723027. Details of each certification follow.

Hospital certification: CCN 23T031

Legal name
PRIME HEALTHCARE SERVICES-PORT HURON LLC
Doing business as
LAKE HURON MEDICAL CENTER
Organization structure
LLCProprietary
Enrollment address
2601 Electric Ave
Port Huron, MI 48060-6587
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

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: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Lake Huron Medical CenterCCN 23T031 · All quality measures
Ownership
Non-profit
Certified
Jul 1, 1990

National Provider Directory

National Provider Directory
Tax ID family
Prime Healthcare Services-Port Huron LLC5 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 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 OtherChief Financial Officer 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

Affiliated clinicians 3

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

NPI Registry JSON

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

{
    "created_epoch": "1434585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1434585600000",
    "number": "1356723027",
    "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": "2015-06-18",
        "last_updated": "2015-06-18",
        "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": "Ms."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "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.