Active NPI
Trinity Health-Michigan
- Community/Retail Pharmacy
- Rockford, MI
National Provider Identifier
1700260916
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community/Retail Pharmacy
- License
- 5301010706
- Legal business name
- TRINITY HEALTH-MICHIGAN
- Practice address
- 6050 Northland Dr NE
Suite 1107
Rockford, MI 49341-9256 - Phone
- (616) 685-7990
- Fax
- (616) 685-7998
- NPI assigned
- Jul 17, 2015
- Organization subpart
- Yes
- Parent organization
- TRINITY HEALTH - MICHIGAN
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Robert Casalou
- Title
- President/Ceo
- Phone
- (734) 712-3792
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community/Retail Pharmacy | 3336C0003X | 5301010706 | MI | Primary |
Addresses
Primary practice location
6050 Northland Dr NE
Suite 1107
Rockford, MI 49341-9256
Mailing address
6050 Northland Dr NE
Suite 1107
Rockford, MI 49341-9256
Phone (616) 685-7990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700260916 | Medicaid | MI |
Other names 2
- MERCY HEALTH PHARMACY - ROCKFORD
- Trinity Health Pharmacy - Rockford
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200604002163 | MI | Part B Supplier - Mass Immunization (Roster Biller Only) | 7618878943 |
7 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Grand Rapids, MI; Howell, MI; Hudsonville, MI; Livonia, MI; Pontiac, MI; Rockford, MI; Ypsilanti, MI |
Other NPIs on the same Medicare enrollment 7
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2303370 | Trinity Health - Rockford | Accreditation | May 6, 2027 |
National Provider Directory
National Provider Directory- Part of
- Mercy Health Services
Locations
360 Division Ave S
Ste 1E
Grand Rapids, MI 49503
Phone (616) 685-1080
6050 Northland Dr NE
Ste 1107
Rockford, MI 49341
Phone (616) 685-7990
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1437091200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1664150400000",
"number": "1700260916",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6050 NORTHLAND DR NE",
"address_2": "SUITE 1107",
"city": "ROCKFORD",
"state": "MI",
"postal_code": "493419256",
"telephone_number": "616-685-7990",
"fax_number": "616-685-7998"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6050 NORTHLAND DR NE",
"address_2": "SUITE 1107",
"city": "ROCKFORD",
"state": "MI",
"postal_code": "493419256",
"telephone_number": "616-685-7990",
"fax_number": "616-685-7998"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TRINITY HEALTH-MICHIGAN",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "TRINITY HEALTH - MICHIGAN",
"enumeration_date": "2015-07-17",
"last_updated": "2022-09-26",
"certification_date": "2022-09-26",
"status": "A",
"authorized_official_last_name": "CASALOU",
"authorized_official_first_name": "ROBERT",
"authorized_official_title_or_position": "PRESIDENT/CEO",
"authorized_official_telephone_number": "734-712-3792"
},
"taxonomies": [
{
"code": "3336C0003X",
"taxonomy_group": "",
"desc": "Pharmacy, Community/Retail Pharmacy",
"state": "MI",
"license": "5301010706",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1700260916",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "MERCY HEALTH PHARMACY - ROCKFORD",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "MERCY HEALTH PHARMACY - ROCKFORD",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Trinity Health Pharmacy - Rockford",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Rockford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.