NPIMap

Organization Active NPI

Eaton Rapids Medical Center

  • Critical Access Hospital
  • Eaton Rapids, MI
National Provider Identifier
1417044660
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
230010 Issued in MI
Legal business name
EATON RAPIDS MEDICAL CENTER
Practice address
1500 S Main St
Eaton Rapids, MI 48827-1952
Phone
(517) 663-2671
Fax
(517) 663-2472
NPI assigned
Oct 9, 2006
Last updated
Mar 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Authorized official

Name
Mr. Timothy J. Johnson, CPA
Title
Chief Executive Officer
Phone
(517) 663-9474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 230010 MI Primary

Addresses

Primary practice location

1500 S Main St
Eaton Rapids, MI 48827-1952

Mailing address

1500 S Main St
Eaton Rapids, MI 48827-1952
Phone (517) 663-2671

Other identifiers 4

IdentifierTypeStateIssuer
OB37608OtherMIMEDICARE PTAN
5170569MedicaidMI
OB37608OtherMIBCBS GROUP PIN
00197OtherMIBLUE CROSS

Other names 1

  • Eaton Rapids Community Hospital Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
O20040301000307 MI Part B Supplier - Clinic/Group Practice 5991692634 Receives reassigned benefits from 56 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI; Springport, MI; Eaton Rapids, MI
O20070223000658 MI Part A Provider - Critical Access Hospital 5991692634 Receives reassigned benefits from 46 practitioners
1 other NPI on this enrollment
Practice locations: Eaton Rapids, MI
O20080119000106 MI Part B Supplier - Clinic/Group Practice 5991692634 Receives reassigned benefits from 4 practitioners
Practice locations: Eaton Rapids, MI
O20101014001197 MI Part A Provider - Rural Health Clinic 5991692634 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eaton Rapids, MI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1417044660. Details of each certification follow.

Hospital certification: CCN 231324

Legal name
EATON RAPIDS MEDICAL CENTER
Doing business as
EATON RAPIDS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2005
Last certification
Jul 27, 2005
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Enrollment address
1500 S Main St
Eaton Rapids, MI 48827-0130

Rural health clinic certification: CCN 238633

Legal name
EATON RAPIDS MEDICAL CENTER
Doing business as
EATON RAPIDS MEDICAL CENTER FAMILY PRACTICE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 6, 2011
Last certification
Apr 23, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jan 8, 1954 in MI
Enrollment address
1500 S Main St
Eaton Rapids, MI 48827-1952
Related CCNs
231324

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

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

Other NPIs on the same Medicare enrollment 5

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Eaton Rapids Medical CenterCCN 231324 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory

Locations

1500 S Main St
#C
Eaton Rapids, MI 48827

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Shari L Glynn Individual Corporate OfficerVP of Finance, Cfo Oct 1, 2010
W-2 Managing Employee Oct 1, 2010
Corporate OfficerVP of Finance/Cfo Oct 1, 2012
Operational/Managerial ControlVP of Finance/Cfo Oct 1, 2012
Ashok K Gupta Individual Corporate Director Oct 1, 2007
Corporate DirectorBoard Member- Director Oct 1, 2002
Thomas a Kelly Individual Corporate Director Mar 1, 2011
Corporate DirectorBoard Member- Director Oct 1, 2012
Timothy J Johnson Individual Corporate OfficerPresident/Ceo Aug 1, 2010
Corporate OfficerChief Operations Officer Oct 1, 2009
W-2 Managing Employee Oct 1, 2009

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 59

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 59

Affiliated clinicians 103

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

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1417044660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "488271952",
            "telephone_number": "517-663-2671",
            "fax_number": "517-663-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "488271952",
            "telephone_number": "517-663-2671",
            "fax_number": "517-663-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATON RAPIDS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-09",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "517-663-9474",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MI",
            "license": "230010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "OB37608",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170569",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP PIN",
            "identifier": "OB37608",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00197",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eaton Rapids Community Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eaton Rapids, MI

Sources for this page

Verify at the official NPI Registry.