NPIMap

Organization Active NPI

Wa Foote Memorial Hospital

Doing business as Henry Ford Allegiance Health

  • Obesity Medicine (Internal Medicine) Physician
  • Jackson, MI
National Provider Identifier
1700355195
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obesity Medicine (Internal Medicine) PhysicianTaxonomy code 207RB0002X
Legal business name
WA FOOTE MEMORIAL HOSPITAL
Doing business as
Henry Ford Allegiance Health
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-3867
Fax
(517) 803-2133
NPI assigned
Nov 15, 2018
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
W A FOOTE MEMORIAL HOSPITAL INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 6, 2024

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

Authorized official

Name
Mark Smith
Title
SVP, Cmo
Phone
(517) 205-6407

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X NU
Obesity Medicine (Family Medicine) Physician 207QB0002X NU
Obesity Medicine (Internal Medicine) Physician 207RB0002X NU Primary
Obesity Medicine (Psychiatry & Neurology) Physician 2084B0002X NU

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

PO Box 67000, Department 272801
Detroit, MI 48267-2728
Phone (517) 205-3867

Other names 1

  • Henry Ford Allegiance Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000691 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 485 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI; Albion, MI; Jonesville, MI; Leslie, MI; Marshall, MI; Mason, MI; Onsted, MI; Spring Arbor, MI…

National Provider Directory

National Provider Directory
Tax ID family
Jackson Speech and Hear104 organizations share this tax ID, including this one
Part of
Jackson Speech and Hear

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1542240000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1700355195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000, DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672728",
            "telephone_number": "517-205-3867",
            "fax_number": "517-803-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-3867",
            "fax_number": "517-803-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WA FOOTE MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "W A FOOTE MEMORIAL HOSPITAL INC",
        "enumeration_date": "2018-11-15",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SVP, CMO",
        "authorized_official_telephone_number": "517-205-6407"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RB0002X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2084B0002X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Obesity Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.