NPIMap

Organization Active NPI

Eaton Rapids Medical Center

  • Medicare Defined Swing Bed Hospital Unit
  • Eaton Rapids, MI
National Provider Identifier
1629294046
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
230010 Issued in MI
Legal business name
EATON RAPIDS MEDICAL CENTER
Practice address
1500 S Main St
Eaton Rapids, MI 48827-1952
Phone
(517) 663-2671
Fax
(517) 663-2472
NPI assigned
Apr 17, 2007
Last updated
Mar 2, 2022By the provider in NPPES
Organization subpart
No

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
Title
Chief Executive Officer
Phone
(517) 663-9474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 230010 MI Primary

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) 663-2671

Other names 1

  • Eaton Rapids Community Hospital Former legal business name

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
O20061104000616 MI Part A Provider - Critical Access Hospital 5991692634 Practice locations: Eaton Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629294046. Details of each certification follow.

Hospital certification: CCN 23Z324

Legal name
EATON RAPIDS MEDICAL CENTER
Organization structure
OtherNon-profit
Enrollment address
1500 South Main
Eaton Rapids, MI 48827
Hospital Swing-Bed Unit

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.

National Provider Directory

National Provider Directory
Tax ID family
Eaton Rapids Medical Ce7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 5

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 Officer Oct 1, 2010
W-2 Managing EmployeeVP of Finance/Cfo Oct 1, 2010
Robert Dickins Individual Corporate Director Nov 1, 2019
Russell L Halsey Individual Corporate Director Nov 1, 2019
Ashok K Gupta Individual Corporate Director Oct 1, 2007
Timothy J Johnson Individual Corporate OfficerPresident/ Ceo Sep 1, 2007
W-2 Managing EmployeePresident/ Ceo Sep 1, 2007
Operational/Managerial ControlPresident/ Ceo Sep 1, 2010

Owners & managing parties with NPI records 1

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

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1629294046",
    "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": "517-663-2671",
            "fax_number": "517-663-2472"
        },
        {
            "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": "517-663-2671",
            "fax_number": "517-663-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATON RAPIDS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "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 EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "517-663-9474",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MI",
            "license": "230010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eaton Rapids Community Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eaton Rapids, MI

Sources for this page

Verify at the official NPI Registry.