NPIMap

Organization Active NPI

Eaton Rapids Medical Center

Doing business as Eaton Rapids Medical Center Family Practice

  • Rural Health Clinic/Center
  • Eaton Rapids, MI
National Provider Identifier
1437383296
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
230010 Issued in MI
Legal business name
EATON RAPIDS MEDICAL CENTER
Doing business as
Eaton Rapids Medical Center Family Practice
Practice address
1500 S Main St
Eaton Rapids, MI 48827-1952
Phone
(517) 999-4500
Fax
(517) 999-4510
NPI assigned
May 8, 2009
Last updated
Mar 2, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
EATON RAPIDS MEDICAL CENTERAs reported in NPPES

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 Operating Officer
Phone
(517) 663-9474

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 230010 MI Primary
Critical Access Hospital 282NC0060X 230010 MI
Family Medicine Physician 207Q00000X NU

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) 999-4500

Other identifiers 2

IdentifierTypeStateIssuer
OB37608OtherMIMEDICARE PTAN
5170569MedicaidMI

Other names 1

  • Eaton Rapids Medical Center Family Practice Doing business as

Medicare participation

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

Enrollment records 2

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
O20101014001197 MI Part A Provider - Rural Health Clinic 5991692634 1 other NPI on this enrollment
Practice locations: Eaton Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437383296. Details of each certification follow.

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 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1098875Eaton Rapids Family Practice & Redicare1500 S Main Street Entrance C, Eaton Rapids, MI 48827Certificate of waiverJan 7, 2028

National Provider Directory

National Provider Directory
Part of
Kevin Waits DO

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, 2012
Operational/Managerial ControlVP of Finance/Cfo Oct 1, 2012
Ashok K Gupta Individual Corporate DirectorBoard Member- Director Oct 1, 2002
Thomas a Kelly Individual Corporate DirectorBoard Member- Director Oct 1, 2012
Timothy J Johnson Individual 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 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1437383296",
    "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": "517-999-4500",
            "fax_number": "517-999-4510"
        },
        {
            "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": "517-999-4500",
            "fax_number": "517-999-4510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATON RAPIDS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EATON RAPIDS MEDICAL CENTER",
        "enumeration_date": "2009-05-08",
        "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 OPERATING OFFICER",
        "authorized_official_telephone_number": "517-663-9474",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": "230010",
            "primary": true
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MI",
            "license": "230010",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "OB37608",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170569",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eaton Rapids Medical Center Family Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eaton Rapids, MI

Sources for this page

Verify at the official NPI Registry.