Sparrow Carson Hospital
Organization Active NPI Rural Health Clinic/Center · Carson City, MI
NPI 1699200550 · NPPES record last updated Apr 8, 2024
Key facts
- NPI
- 1699200550
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- SPARROW CARSON HOSPITAL
- Practice address
- 639 E Main St
Carson City, MI 48811-9795 - Phone
- (989) 584-3107
- NPI assigned
- Apr 27, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- SPARROW HEALTH SYSTEM
Authorized official
- Name
- Misty Gunter Russian
- Title
- Supervisor, Provider Enrollment
- Phone
- (517) 253-6308
Owners & managing parties with NPI records 4
-
Gregory A Holzhei, D.O.
-
Lakeeya K Tucker, DO
-
Matthew D Wilcox, DO
-
Harper T Wildern, O.D.
Other NPIs with the same Medicare PAC ID 7
Corporate family (same tax ID) 18
Related certifications (CCN) 1
Facilities with the same owner 17
Practitioners 63
-
Iftiker Ahmad, MD
-
Alicia Lynn Ballard, D.O.
-
Appa Rao Bandi, MD
-
Chelsea N Barnes, FNP-C
-
Mary Lynne Barringer, WHNP-BC
-
Spencer Batten, DO
-
Michelle Leigh Becher, D.O., FACOOG
-
Amanda Elizabeth Bennett, FNP-C
-
Shelly L Betancourt, MSN,MHA,WHNP-BC
-
Parut R Bhimalli, MD
-
Stephanie M Dailey, PA-C
-
Eric J Egeler, M.D.
-
Jamie E. Furness, MD
-
Annie Garn, RN, NP
-
Holly Noelle Hnetynka, PA-C
-
Ronald Allen Hyde, D.O.
-
Amy B Jentz, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0722626 | University of Michigan Health Sparrow | Provider-performed microscopy | Apr 15, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Rural health clinic certification: CCN 238706
- Legal name
- SPARROW CARSON HOSPITAL
- Doing business as
- UNIVERSITY OF MICHIGAN HEALTH-SPARROW CARSON OB/GYN
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Feb 6, 2018
- Last certification
- Feb 6, 2018
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 639 E Main St
Carson City, MI 48811-9795 - Related CCNs
- 230208
All disclosed owners & managing parties 18
| Name | Role | Since | Share |
|---|---|---|---|
| Matthew D Wilcox |
Corporate Officer |
Jul 1, 2025 | |
| Eric J Strucko |
Corporate Officer |
Jul 1, 2025 | |
| Laura M Gibson |
Corporate Officer |
Jul 1, 2025 | |
| Um Health |
5% Or Greater Indirect Ownership Interest | Apr 1, 2023 | 100% |
| Candace S Metcalf |
Corporate Officer |
Jul 1, 2025 | |
| Harper T Wildern |
Corporate Officer |
Jul 1, 2025 | |
| Margaret a Dimond |
Corporate Officer |
Jan 1, 2024 | |
| W-2 Managing Employee |
Jan 1, 2024 | ||
| Misty Gunter Russian |
W-2 Managing Employee |
Jan 1, 2024 | |
| Daniel Balice |
Corporate Officer |
Jul 1, 2025 | |
| Carol Priebe Wiles |
Corporate Officer |
Jul 1, 2025 | |
| Sparrow Health System |
5% Or Greater Direct Ownership Interest | Dec 23, 1996 | 100% |
| John Milewski |
Corporate Officer |
Jul 1, 2025 | |
| Gregory a Holzhei |
Corporate Officer |
Jul 1, 2025 | |
| John Hendrickson |
Corporate Officer |
Jul 1, 2025 | |
| Bruce a Courtade |
Corporate Officer |
Jul 1, 2025 | |
| Anthony Mazzali |
Corporate Officer |
Jul 1, 2025 | |
| Timothy L Williams |
Corporate Officer |
Jul 1, 2025 | |
| Lakeeya K Tucker |
Corporate Officer |
Jul 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170605000135 | MI | Part a Provider - Rural Health Clinic | 7113836701 | Practice locations: Carson City, MI |
National Provider Directory
- Tax ID family
- Rickey J Coleman DO
- Part of
- Sparrow Health System
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
639 E Main St
Carson City, MI 48811-9795
Mailing address
8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (989) 584-0105
Other names
- University of Michigan Health-Sparrow
- Sparrow Medical Group OB/GYN Carson City
- University of Michigan Health-Sparrow Carson OB/GYN
Other providers in Carson City, MI
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
- Sparrow Carson Hospital
All providers in Carson City, MI · Rural Health Clinic/Center 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 8, 2024. 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.