NPIMap

Organization Active NPI

Mercy Health Partners

Doing business as Trinity Health Medical Group Primary Care Shelby

  • Rural Health Clinic/Center
  • Shelby, MI
National Provider Identifier
1588080030
Registry record updated Oct 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MERCY HEALTH PARTNERS
Doing business as
Trinity Health Medical Group Primary Care Shelby
Practice address
71 Bevier St
Shelby, MI 49455-1209
Phone
(231) 861-2187
Fax
(231) 861-5100
NPI assigned
Mar 7, 2014
Last updated
Oct 6, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MERCY HEALTH PARTNERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 6, 2026

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

Authorized official

Name
Ariana Grace Raymond
Title
Manager, Entity Provider Enrollment
Phone
(734) 343-1466

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

71 Bevier St
Shelby, MI 49455-1209

Mailing address

PO Box 932988
Cleveland, OH 44193-0029
Phone (800) 494-5797

Other names 1

  • Trinity Health Medical Group Primary Care Shelby Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140410000571 MI Part A Provider - Rural Health Clinic 1456430016 Practice locations: Shelby, MI
O20140415001839 MI Part B Supplier - Clinic/Group Practice 1456430016 Receives reassigned benefits from 120 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hart, MI; Ludington, MI; Muskegon, MI; Shelby, MI; Sparta, MI; Whitehall, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1588080030. Details of each certification follow.

Rural health clinic certification: CCN 238624

Legal name
MERCY HEALTH PARTNERS
Doing business as
TRINITY HEALTH MEDICAL GROUP, PRIMARY CARE - SHELBY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jan 1, 2009
Last certification
Feb 19, 2026
Ownership / control type
1B
Most recent change of ownership
Jan 1, 2014 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
71 Bevier St
Shelby, MI 49455-1209
Related CCNs
231320

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

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 11

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

National Provider Directory

National Provider Directory
Part of
Mercy Health Partners

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
William Morris Individual Corporate DirectorBoard Member Mar 1, 2022
Edmund F Hodge Individual Corporate DirectorBoard Member Jan 1, 2019
Carolyn L Rombach Individual W-2 Managing EmployeePractice Manager III Jun 7, 2021
Operational/Managerial ControlPractice Manager III Jun 7, 2021
Spencer T Maidlow Individual Corporate DirectorBoard Member Jan 1, 2019
Michael Williams Individual Corporate DirectorBoard Member Jan 1, 2025
Linda J Werthman Individual Corporate DirectorBoard Member Aug 1, 2020
Sara Dolan Individual Corporate DirectorBoard Member Jan 1, 2025
Suzanne Mellon Individual Corporate DirectorBoard Member Aug 3, 2021
Paula Chermside Individual Corporate DirectorBoard Member Jan 1, 2026
Shannon Striebich Individual Corporate OfficerPresident and Ceo Jul 1, 2024
Corporate DirectorBoard Member Jul 1, 2024
Michael P Gusho Individual Corporate OfficerCfo & Treasurer Jan 4, 2018
Joseph Fleck Individual Corporate DirectorBoard Member Jan 1, 2026
Julie a Shellhouse Individual Contracted Managing EmployeePhysician Lead Jan 1, 2017
Operational/Managerial ControlPhysician Lead Jan 1, 2017
Trinity Health-Michigan Organization, Livonia, MI Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Apr 1, 2008 100%
Christian Schafer Individual Corporate OfficerSecretary Jan 1, 2026
Eric C Ferguson Individual Corporate DirectorBoard Member Aug 3, 2021
Gary Edward Allore Individual Corporate OfficerPresident Sep 1, 2017
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Apr 1, 2008 100%
Jean M Nagelkerk Individual Corporate OfficerVice Chair Jan 1, 2025
Corporate DirectorBoard Member Jan 1, 2019
Wayman P Britt Individual Corporate OfficerChair Jan 1, 2025
Corporate DirectorBoard Member Mar 31, 2019

Owners & managing parties with NPI records 4

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

Facilities with the same owner 158

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 158

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1394150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791244800000",
    "number": "1588080030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932988",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930029",
            "telephone_number": "800-494-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "71 BEVIER ST",
            "city": "SHELBY",
            "state": "MI",
            "postal_code": "494551209",
            "telephone_number": "231-861-2187",
            "fax_number": "231-861-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY HEALTH PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY HEALTH PARTNERS",
        "enumeration_date": "2014-03-07",
        "last_updated": "2026-10-06",
        "certification_date": "2026-10-06",
        "status": "A",
        "authorized_official_last_name": "RAYMOND",
        "authorized_official_first_name": "ARIANA",
        "authorized_official_middle_name": "GRACE",
        "authorized_official_title_or_position": "MANAGER, ENTITY PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "734-343-1466"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Trinity Health Medical Group Primary Care Shelby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shelby, MI

Sources for this page

Verify at the official NPI Registry.