NPIMap

Organization Active NPI

Sheridan Community Hospital

  • Critical Access Hospital
  • Sheridan, MI
National Provider Identifier
1689618324
Registry record updated Apr 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 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
Last updated
Apr 22, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2021

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

Authorized official

Name
Ljiljana Petricevic
Title
Ceo
Phone
(989) 291-6222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070301000099 MI Part A Provider - Critical Access Hospital 1658275342 Receives reassigned benefits from 14 practitioners
Practice locations: Sheridan, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1689618324. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
301 N Main St
Box 279
Sheridan, MI 48884-9235

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Sheridan Community HospitalCCN 231312 · All quality measures
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Sheridan Community Hosp6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

301 N Main St
#279
Sheridan, MI 48884
Phone (989) 291-3261

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Jalil Rizqallah Individual Corporate DirectorBoard President Oct 2, 2019
Ljiljana Petricevic Individual Corporate OfficerCeo Apr 29, 2020 100%
Operational/Managerial ControlCeo Apr 29, 2020 100%

Practitioners & affiliated clinicians

Practitioners 14

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 14

Affiliated clinicians 56

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

View all 56

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619049600000",
    "number": "1689618324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 N MAIN ST",
            "address_2": "PO BOX 279",
            "city": "SHERIDAN",
            "state": "MI",
            "postal_code": "488849235",
            "telephone_number": "989-291-3261",
            "fax_number": "989-291-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 N MAIN ST",
            "city": "SHERIDAN",
            "state": "MI",
            "postal_code": "488849235",
            "telephone_number": "989-291-3261",
            "fax_number": "989-291-3062"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERIDAN COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2021-04-22",
        "certification_date": "2021-04-22",
        "status": "A",
        "authorized_official_last_name": "PETRICEVIC",
        "authorized_official_first_name": "LJILJANA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-291-6222"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sheridan, MI

Sources for this page

Verify at the official NPI Registry.