NPIMap

Organization Active NPI

Hospice of Michigan, Inc.

Doing business as Hospice of Southeastern Michigan

  • Community Based Hospice Care Agency
  • Southfield, MI
National Provider Identifier
1689616054
Registry record updated Nov 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
HOSPICE OF MICHIGAN, INC.
Doing business as
Hospice of Southeastern Michigan
Practice address
400 Galleria Officentre Ste 400
Southfield, MI 48034-2162
Phone
(248) 353-2070
NPI assigned
Jun 12, 2006
Last updated
Nov 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2024

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

Authorized official

Name
Lee Ann Myers
Title
Chief Administrative Officer
Phone
(313) 578-6244

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X NU Primary

Addresses

Primary practice location

400 Galleria Officentre Ste 400
Southfield, MI 48034-2162

Mailing address

2366 Oak Valley Dr
Ann Arbor, MI 48103-8944
Phone (248) 353-2070

Other practice location 1

3200 Greenfield Rd Ste 250
Dearborn, MI 48120-1800
Phone (989) 358-4280

Other practice location 2

39531 Garfield Rd
Clinton Twp, MI 48038-4300
Phone (586) 263-8854

Other practice location 3

43097 Woodward Ave Ste 102
Bloomfield Hills, MI 48302-5042
Phone (248) 353-2070

Other identifiers 2

IdentifierTypeStateIssuer
08756OtherMIBLUE CROSS BLUE SHIELD
151796120MedicaidMI

Other names 1

  • Hospice of Southeastern Michigan Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050411000211 MI Part A Provider - Hospice 5496723660 Practice locations: Southfield, MI; Detroit, MI; Clinton TWP, MI; Dearborn, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689616054. Details of each certification follow.

Hospice certification: CCN 231501

Legal name
HOSPICE OF MICHIGAN, INC.
Doing business as
HOSPICE OF SOUTHEASTERN MICHIGAN, INC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 1, 1983
Last certification
Feb 28, 2020
Ownership / control type
Non-Profit - Private
Organization structure
CorporationNon-profit
Incorporated
Oct 20, 1978 in MI
Enrollment address
400 Galleria Officentre
Ste 400
Southfield, MI 48034-2162

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Hospice of Southeastern Michigan, IncCCN 231501 · All quality measures
Ownership
Other
Certified
Nov 1, 1983
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0877024Hospice of Michigan, Inc400 Galleria Officentre Suite 400, Southfield, MI 48034Certificate of waiverSep 27, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hospice of Michigan Inc4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Locations

3200 Greenfield Rd
Ste 250
Dearborn, MI 48120
Phone (313) 563-3332

26957 Northwestern Hwy
Ste 120
Southfield, MI 48033
Phone (313) 938-2144

Ownership & related parties

All disclosed owners & managing parties 24

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

NameRoleSinceShare
Michael L Damstra Individual Corporate DirectorBoard Member Jan 1, 2018
Sanford J Linden Individual Corporate DirectorBoard Member Jul 19, 2005
Bradley Killaly Individual Corporate DirectorBoard Member Feb 22, 2023
Marcie M Hillary Individual Corporate OfficerChief Development Officer Jan 26, 2011
Patrick Miller Individual Corporate OfficerChief Executive Officer Mar 6, 2014
Corporate DirectorBoard Member Jan 1, 2024
Kai Denski Individual W-2 Managing EmployeeMedical Director Jul 3, 2018
Brian M Connolly Individual Corporate DirectorBoard Member Feb 15, 2012
Eric Kaplan Individual Corporate OfficerVice President May 1, 2025
Lee Ann Myers Individual Corporate OfficerChief Administrative Officer Jan 1, 2012
W-2 Managing Employee Jan 1, 2012
Molly Petersen Individual Corporate DirectorBoard Member Aug 1, 2025
Krista Newman Individual Corporate OfficerChief Operating Officer Jan 1, 2024
Mary Sanders Individual Corporate DirectorBoard Member Jul 19, 2005
Hospice of Michigan, Inc. Organization, Ann Arbor, MI Non-profit Operational/Managerial Control Sep 30, 1994 100%
Sarah Posa Individual W-2 Managing EmployeeAdministrator Feb 28, 2021
Kurt Ludlow Individual Corporate DirectorBoard Member Nov 12, 2009
Steven C Wade Individual Corporate DirectorBoard Member Jan 1, 2024
John Evangelisita Individual Corporate DirectorBoard Member Jan 1, 2014
Melissa D Ring Individual W-2 Managing EmployeeAssociate Vice President Feb 1, 2024
Gerald Fitzgerald Individual Corporate DirectorBoard Member Dec 1, 2007
John Raymond Maurer Individual Corporate DirectorBoard Member Jul 19, 2005
Jane McNamara Individual Corporate DirectorBoard Member Jul 19, 2005
Nancy Lynn Philappart Individual Corporate DirectorBoard Member Jan 1, 2024
Jamie L Cockerel Individual Corporate OfficerChief Financial Officer May 1, 2025
Michael a Jones Individual Corporate DirectorBoard Member Aug 1, 2025

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 4

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

FacilityTypeRoleSince
Centrica Care NavigatorsKalamazoo, MI, CCN 231505 Hospice Operational/Managerial Control Feb 1, 2024
Hospice of Western Michigan, Inc.Ada, MI, CCN 231510 Hospice Operational/Managerial Control (100%) Jan 1, 1987
Hospice of Mecosta CountyBig Rapids, MI, CCN 231556 Hospice Operational/Managerial Control (100%) Sep 30, 1994
Arbor Hospice and Home CareAnn Arbor, MI, CCN 231526 Hospice 5% Or Greater Direct Ownership Interest (100%) Jan 1, 2016

Owned or controlled facilities with NPI records 4

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

Facilities with the same owner 4

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

Practitioners & affiliated clinicians

Affiliated clinicians 8

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": "1150070400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732579200000",
    "number": "1689616054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2366 OAK VALLEY DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481038944",
            "telephone_number": "248-353-2070"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 GALLERIA OFFICENTRE STE 400",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480342162",
            "telephone_number": "248-353-2070"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 Greenfield Rd Ste 250",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481201800",
            "country_code": "US",
            "telephone_number": "989-358-4280",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "39531 Garfield Rd",
            "address_purpose": "LOCATION",
            "city": "Clinton Twp",
            "state": "MI",
            "postal_code": "480384300",
            "country_code": "US",
            "telephone_number": "586-263-8854",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "43097 Woodward Ave Ste 102",
            "address_purpose": "LOCATION",
            "city": "Bloomfield Hills",
            "state": "MI",
            "postal_code": "483025042",
            "country_code": "US",
            "telephone_number": "248-353-2070",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "HOSPICE OF MICHIGAN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-12",
        "last_updated": "2024-11-26",
        "certification_date": "2024-11-25",
        "status": "A",
        "authorized_official_last_name": "MYERS",
        "authorized_official_first_name": "LEE ANN",
        "authorized_official_title_or_position": "CHIEF ADMINISTRATIVE OFFICER",
        "authorized_official_telephone_number": "313-578-6244"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "08756",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151796120",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice of Southeastern Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Southfield, MI

Sources for this page

Verify at the official NPI Registry.