NPIMap

Organization Active NPI

Mercy Memorial Hospital Corporation

  • Family Medicine Physician
  • Monroe, MI
National Provider Identifier
1659614022
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301069503 Issued in MI
Legal business name
MERCY MEMORIAL HOSPITAL CORPORATION
Practice address
650 Steward Road
Monroe, MI 48162
Phone
(734) 240-8430
NPI assigned
Apr 3, 2013
Organization subpart
Yes
Parent organization
MERCY MEMORIAL HOSPITAL SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

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

Authorized official

Name
Annette Phillips
Title
MMHS-Ceo
Phone
(734) 240-4550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 4301069503 MI Primary

Addresses

Primary practice location

650 Steward Road
Monroe, MI 48162

Mailing address

650 Steward Road
Monroe, MI 48162
Phone (734) 240-8430

Other names 1

  • Family Medicine Residency Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061212000299 MI Part B Supplier - Clinic/Group Practice 7012811615 Receives reassigned benefits from 60 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Temperance, MI; Newport, MI; Monroe, MI; Luna Pier, MI; Dundee, MI; Carleton, MI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Mercy Memorial Home HLT10 organizations share this tax ID, including this one
Part of
Mercy Memorial Home HLT

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1364947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1659614022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 STEWARD ROAD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "48162",
            "telephone_number": "734-240-8430"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 STEWARD ROAD",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "48162",
            "telephone_number": "734-240-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MERCY MEMORIAL HOSPITAL SYSTEM",
        "enumeration_date": "2013-04-03",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "MMHS-CEO",
        "authorized_official_telephone_number": "734-240-4550"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301069503",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medicine Residency Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; 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.