NPIMap

Organization Active NPI

Edward W. Sparrow Hospital Association

Doing business as SRCC Pediatric Hospitalist

  • Pediatrics Physician
  • Lansing, MI
National Provider Identifier
1720034499
Registry record updated Mar 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
EDWARD W. SPARROW HOSPITAL ASSOCIATION
Doing business as
SRCC Pediatric Hospitalist
University of Michigan Health-Sparrow Pediatric Hospitalists
Practice address
1200 E Michigan Ave
Suite 460
Lansing, MI 48912-1800
Phone
(517) 364-2097
Fax
(517) 364-2077
NPI assigned
May 25, 2006
Last updated
Mar 27, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARROW HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 27, 2024

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

Authorized official

Name
Misty Gunter Russian
Title
Supervisor, Provider Enrollment
Phone
(517) 253-6308

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X Primary

Addresses

Primary practice location

1200 E Michigan Ave
Suite 460
Lansing, MI 48912-1800

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 364-2097

Other identifiers 1

IdentifierTypeStateIssuer
350C313590OtherMIBCBS GROUP NUMBER

Other names 2

  • SRCC Pediatric Hospitalist Doing business as
  • UNIVERSITY OF MICHIGAN HEALTH-SPARROW PEDIATRIC HOSPITALISTS Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040102000790 MI Part B Supplier - Clinic/Group Practice 6709799166 Receives reassigned benefits from 965 practitioners
41 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lansing, MI; Mason, MI; Okemos, MI; Owosso, MI; Saint Johns, MI; Williamston, MI; Carson City, MI; Charlotte, MI…

Other NPIs on the same Medicare enrollment 34

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 34

National Provider Directory

National Provider Directory
Tax ID family
Sparrow Hospital Lab49 organizations share this tax ID, including this one
Part of
Sparrow Health System

Other organizations with this tax ID 48

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

View all 48

Practitioners & affiliated clinicians

Practitioners 32

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 32

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711497600000",
    "number": "1720034499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860081",
            "telephone_number": "517-364-2097",
            "fax_number": "517-364-2077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE",
            "address_2": "SUITE 460",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121800",
            "telephone_number": "517-364-2097",
            "fax_number": "517-364-2077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDWARD W. SPARROW HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2006-05-25",
        "last_updated": "2024-03-27",
        "certification_date": "2024-03-27",
        "status": "A",
        "authorized_official_last_name": "RUSSIAN",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "SUPERVISOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "517-253-6308"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "350C313590",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SRCC Pediatric Hospitalist",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SRCC Pediatric Hospitalist",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "UNIVERSITY OF MICHIGAN HEALTH-SPARROW PEDIATRIC HOSPITALISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 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.