NPIMap

Organization Active NPI

Packard Health, Inc.

  • Clinic/Center
  • Ann Arbor, MI
National Provider Identifier
1609988245
Registry record updated Dec 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
PACKARD HEALTH, INC.
Practice address
2650 Carpenter Rd
Ann Arbor, MI 48108-1108
Phone
(734) 971-1073
Fax
(734) 971-8545
NPI assigned
Aug 31, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2022

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

Authorized official

Name
Todd Montrief, CPA
Title
Cfo
Phone
(734) 926-4935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2650 Carpenter Rd
Ann Arbor, MI 48108-1108

Mailing address

5200 Venture Dr
Ann Arbor, MI 48108-9561
Phone (734) 926-4935

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050510001120 MI Part B Supplier - Clinic/Group Practice 6204876113 Receives reassigned benefits from 31 practitioners
2 other NPIs on this enrollment
Practice locations: Ann Arbor, MI; Ypsilanti, MI
O20150313000358 MI Part A Provider - Federally Qualified Health Center (FQHC) 6204876113 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ann Arbor, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609988245. Details of each certification follow.

Federally qualified health center certification: CCN 231050

Legal name
PACKARD HEALTH INC
Doing business as
PACKARD HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2015
Last certification
Mar 16, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
1915 Pauline Blvd
Ann Arbor, MI 48103-5001

Other NPIs with the same Medicare PAC ID 6

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

Locations

3174 Packard St
Ann Arbor, MI 48108
Phone (734) 971-1073

200 Arnet St
Ste 1
Ypsilanti, MI 48198

200 Arnet St
Ste 150
Ypsilanti, MI 48198
Phone (734) 985-7200

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Raymond J Rion Individual Corporate DirectorExecutive Director Nov 16, 2012
David Hoffman Individual Corporate OfficerCfo Jan 9, 2023
W-2 Managing EmployeeCfo Jan 9, 2023

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Packard Health IncYpsilanti, MI, CCN C71021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 12, 1989

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 40

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 40

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670544000000",
    "number": "1609988245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VENTURE DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089561",
            "telephone_number": "734-926-4935",
            "fax_number": "734-773-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 CARPENTER RD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081108",
            "telephone_number": "734-971-1073",
            "fax_number": "734-971-8545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACKARD HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2022-12-09",
        "certification_date": "2022-12-09",
        "status": "A",
        "authorized_official_last_name": "MONTRIEF",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "734-926-4935",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.