NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital, Inc

Doing business as Henry Ford Allegiance Health

  • Nurse Practitioner
  • Jackson, MI
National Provider Identifier
1629000708
Registry record updated Oct 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL, INC
Doing business as
Henry Ford Allegiance Health
Henry Ford Jackson Health
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4800
NPI assigned
Jul 7, 2006
Last updated
Oct 9, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
WA FOOTE MEMORIAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 9, 2026

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

Authorized official

Name
Kimberly Cebalt
Title
Director
Phone
(313) 874-6764

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

PO Box 670884
Detroit, MI 48267-2728
Phone (800) 999-5829

Other identifiers 2

IdentifierTypeStateIssuer
500C810570OtherMIBCBSM CNP
CC5829OtherMIRR MEDICARE

Other names 2

  • Henry Ford Allegiance Health Doing business as
  • Henry Ford Jackson Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031212000691 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 485 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI; Albion, MI; Jonesville, MI; Leslie, MI; Marshall, MI; Mason, MI; Onsted, MI; Spring Arbor, MI…
O20040612000395 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 348 practitioners
6 other NPIs on this enrollment
Practice locations: Jackson, MI; Jonesville, MI; Leslie, MI; Mason, MI; Michigan Center, MI; Onsted, MI; Spring Arbor, MI; Marshall, MI…

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 6

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

National Provider Directory

National Provider Directory
Part of
Jackson Speech and Hear

Member of 1

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

Locations

1100 E Michigan Ave
Ste 307
Jackson, MI 49201
Phone (517) 205-1594

2200 Springport Rd
Ste 260
Jackson, MI 49202
Phone (517) 205-3273

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 356

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 356

NPI Registry JSON

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791504000000",
    "number": "1629000708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672728",
            "telephone_number": "800-999-5829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-788-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2006-07-07",
        "last_updated": "2026-10-09",
        "certification_date": "2026-10-09",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM CNP",
            "identifier": "500C810570",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC5829",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Jackson Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.