NPIMap

Organization Active NPI

Sparrow Clinton Hospital

Doing business as University of Michigan Health-Sparrow Clinton Hospital Emergency Depar

  • Emergency Medicine Physician
  • Saint Johns, MI
National Provider Identifier
1396827952
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
SPARROW CLINTON HOSPITAL
Doing business as
University of Michigan Health-Sparrow Clinton Hospital Emergency Depar
Practice address
805 S Oakland St
Saint Johns, MI 48879-2253
Phone
(989) 224-6881
Fax
(989) 227-3347
NPI assigned
Oct 20, 2006
Last updated
Mar 11, 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 11, 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
Emergency Medicine Physician 207P00000X NU Primary

Addresses

Primary practice location

805 S Oakland St
Saint Johns, MI 48879-2253

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (989) 224-6881

Other identifiers 1

IdentifierTypeStateIssuer
0A960020OtherMIBCBSM BILL PIN

Other names 1

  • UNIVERSITY OF MICHIGAN HEALTH-SPARROW CLINTON HOSPITAL EMERGENCY DEPAR Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031111000063 MI Part B Supplier - Clinic/Group Practice 5395658850 Receives reassigned benefits from 131 practitioners
3 other NPIs on this enrollment
Practice locations: Saint Johns, MI; St Johns, MI

Other NPIs with the same Medicare PAC ID 2

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

Other NPIs on the same Medicare enrollment 3

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

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Locations

8175 Reliable Pkwy
Chicago, IL 60686

Practitioners & affiliated clinicians

Practitioners 135

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.

View all 135

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1396827952",
    "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": "989-224-6881",
            "fax_number": "989-227-3347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "805 S OAKLAND ST",
            "city": "SAINT JOHNS",
            "state": "MI",
            "postal_code": "488792253",
            "telephone_number": "989-224-6881",
            "fax_number": "989-227-3347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARROW CLINTON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2006-10-20",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "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": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM BILL PIN",
            "identifier": "0A960020",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "UNIVERSITY OF MICHIGAN HEALTH-SPARROW CLINTON HOSPITAL EMERGENCY DEPAR",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Johns, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.