NPIMap

Organization Active NPI

Memorial Hospital

Doing business as Memorial Healthcare

  • General Practice Physician
  • Owosso, MI
National Provider Identifier
1538795356
Registry record updated Apr 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MEMORIAL HOSPITAL
Doing business as
Memorial Healthcare
Practice address
200 Health Park Dr Ste 205
Owosso, MI 48867-1291
Phone
(989) 723-8666
Fax
(989) 725-1434
NPI assigned
Mar 13, 2020
Last updated
Apr 16, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 16, 2024

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

Authorized official

Name
Jorri M Tremain
Title
Cfo
Phone
(989) 729-4466

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X
Nurse Practitioner 363L00000X
General Practice Physician 208D00000X Primary

Addresses

Primary practice location

200 Health Park Dr Ste 205
Owosso, MI 48867-1291

Mailing address

113 E Williams St
Owosso, MI 48867-2360
Phone (989) 725-6528

Other identifiers 1

IdentifierTypeStateIssuer
1538795356MedicaidMI

Other names 1

  • Memorial Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000907 MI Part B Supplier - Clinic/Group Practice 8527976497 Receives reassigned benefits from 363 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Owosso, MI; Perry, MI; Saginaw, MI; Saint Johns, MI; Howell, MI; Ovid, MI; Okemos, MI; Laingsburg, MI…

Other NPIs on the same Medicare enrollment 6

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
23D0983410Memorial Healthcare Family Medicine -200 Health Park Drive Suite 201, Owosso, MI 48867Certificate of waiverApr 1, 2028

National Provider Directory

National Provider Directory
Part of
Memorial Healthcare Cen

Locations

200 Health Park Dr
Ste 205
Owosso, MI 48867
Phone (989) 723-8666

NPI Registry JSON

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

{
    "created_epoch": "1584057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1713225600000",
    "number": "1538795356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 E WILLIAMS ST",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488672360",
            "telephone_number": "989-725-6528",
            "fax_number": "989-723-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HEALTH PARK DR STE 205",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "488671291",
            "telephone_number": "989-723-8666",
            "fax_number": "989-725-1434"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL HOSPITAL",
        "enumeration_date": "2020-03-13",
        "last_updated": "2024-04-16",
        "certification_date": "2024-04-16",
        "status": "A",
        "authorized_official_last_name": "TREMAIN",
        "authorized_official_first_name": "JORRI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "989-729-4466"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538795356",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Memorial Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Owosso, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.