NPIMap

Organization Active NPI

St Mary Mercy Hospital Professional

  • Community/Behavioral Health Agency
  • Ann Arbor, MI
National Provider Identifier
1386913705
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
ST MARY MERCY HOSPITAL PROFESSIONAL
Practice address
2006 Hogback Rd
Suite 1
Ann Arbor, MI 48105-9750
Phone
(734) 786-2300
Fax
(734) 786-4915
NPI assigned
Dec 14, 2011
Organization subpart
Yes
Parent organization
ST MARY MERCY HOSPITAL PROFESSIONALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Authorized official

Name
David Spivey
Title
President / Ceo
Phone
(734) 655-1610

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

2006 Hogback Rd
Suite 1
Ann Arbor, MI 48105-9750

Mailing address

5301 E Huron River Dr
MC 69504
Ypsilanti, MI 48197-1051
Phone (734) 827-8883

Other identifiers 1

IdentifierTypeStateIssuer
0H10674OtherBCBSM PIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080502000426 MI Part B Supplier - Clinic/Group Practice 2365521226 Receives reassigned benefits from 139 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Livonia, MI; Ypsilanti, MI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
St Mary Mercy Hospital Professional

Locations

2006 Hogback Rd
Ste 1
Ann Arbor, MI 48105
Phone (734) 325-4572

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1323820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454025600000",
    "number": "1386913705",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5301 E HURON RIVER DR",
            "address_2": "MC 69504",
            "city": "YPSILANTI",
            "state": "MI",
            "postal_code": "481971051",
            "telephone_number": "734-827-8883",
            "fax_number": "734-827-8822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2006 HOGBACK RD",
            "address_2": "SUITE 1",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481059750",
            "telephone_number": "734-786-2300",
            "fax_number": "734-786-4915"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST MARY MERCY HOSPITAL PROFESSIONAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST MARY MERCY HOSPITAL PROFESSIONAL",
        "enumeration_date": "2011-12-14",
        "last_updated": "2016-01-29",
        "status": "A",
        "authorized_official_last_name": "SPIVEY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "734-655-1610"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM PIN",
            "identifier": "0H10674",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; 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.