Sheridan Community Hospital
Organization Active NPI Critical Access Hospital · Sheridan, MI
NPI 1689618324 · NPPES record last updated Apr 22, 2021
Key facts
- NPI
- 1689618324
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Critical Access Hospital 282NC0060X
- Legal business name
- SHERIDAN COMMUNITY HOSPITAL
- Practice address
- 301 N Main St
Sheridan, MI 48884-9235 - Phone
- (989) 291-3261
- Fax
- (989) 291-3062
- NPI assigned
- Jun 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Ljiljana Petricevic
- Title
- Ceo
- Phone
- (989) 291-6222
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 4
Related certifications (CCN) 2
Practitioners 28
-
Donald Wolf, CRNA
-
Werner Heinrich Henning, D.O.
-
Gina Louise Bennett, NP-C
-
Matthew B Dewys, DO
-
Stacey R Hinton, FNP-C
-
Nicholas Kolascz, CRNA
-
John Rohan Lobo, M.D.
-
Navneet Singh Mander, M.D.
-
Krista L Rogers, CRNA
-
Joshua Joseph Saladino, CRNA
-
Alex Michael Kolascz, CRNA
-
Jonathan Bisson, PA
-
Anthony Sanford Burgess, M.D.
-
David J Heeringa, D.O.
-
Lisa Ann Pullum, DO
-
Brian Queen, MD
-
Harvinder Paul Singh, M.D.
Affiliated clinicians 56
-
Bryan Chester Bartosik, CRNA
-
Parut R Bhimalli, MD
-
Jonathan Bisson, PA
-
Justine Bollinger, FNP-BC
-
Anthony Sanford Burgess, M.D.
-
Mark Daniel Clark, M.D.
-
Allan G Coates, DO
-
Michelle L Corazza, CRNA
-
Andrew Michael Deneen, CRNA
-
Katheryn E Everts, CRNA
-
Jason David Flowers, CRNA
-
Jose E Fuente, M.D.
-
James Michael Hecksel, D.O.
-
David J Heeringa, D.O.
-
Ryan Holley - Mallo, DNP, FNP-C
-
Sara Hoover, CRNA
-
Aimee Lee Johnson, FNP-C
-
Michael Kelley, DPM
Medicare Care Compare: Hospital
- Listed as
- Sheridan Community Hospital
- Type
- Critical Access Hospitals
- Ownership
- Voluntary non-profit - Private
- Medicare certification status
- Active
- Emergency services
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Hospital certification: CCN 231312
- Legal name
- SHERIDAN COMMUNITY HOSPITAL
- Doing business as
- SHERIDAN COMMUNITY HOSPITAL
- Certification status
- Active
- Provider type (POS)
- Hospital – Critical access hospital
- Participating since
- Sep 1, 2000
- Last certification
- Nov 7, 2014
- Beds
- 25
- Ownership / control type
- Private (not for profit)
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 301 N Main St
Box 279
Sheridan, MI 48884-9235
All disclosed owners & managing parties 2
| Name | Role | Since | Share |
|---|---|---|---|
| Jalil Rizqallah |
Corporate Director |
Oct 2, 2019 | |
| Ljiljana Petricevic |
Corporate Officer |
Apr 29, 2020 | 100% |
| Operational/Managerial Control |
Apr 29, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070301000099 | MI | Part a Provider - Critical Access Hospital | 1658275342 |
Receives reassigned benefits from 14 practitioners Practice locations: Sheridan, MI |
National Provider Directory
- Tax ID family
- Sheridan Community Hospital
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | Yes |
Addresses
Primary practice location
301 N Main St
Sheridan, MI 48884-9235
Mailing address
301 N Main St
PO Box 279
Sheridan, MI 48884-9235
Phone (989) 291-3261
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5171898 | Medicaid | MI | |
| 00057 | Other | MI | BCBSM PROVIDER # |
| 1557346 | Medicaid | MI |
Other providers in Sheridan, MI
- Ellie Rudd
- Ashley S Saylor
- Sheridan Community Hospital
- Sheridan Community Hospital
- Sheridan Community Hospital
- Sheridan Community Hospital
- Sheridan Community Hospital
- Sheridan Village Pharmacy LLC
- Emily Ann Snyder
- Spectrum Health Primary Care Partners
All providers in Sheridan, MI · Critical Access Hospital in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.