NPIMap

Organization Active NPI

Eaton Rapids Medical Center

  • Emergency Medicine Physician
  • Eaton Rapids, MI
National Provider Identifier
1730237165
Registry record updated Mar 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
230010 Issued in MI
Legal business name
EATON RAPIDS MEDICAL CENTER
Practice address
1500 S Main St
Eaton Rapids, MI 48827-1952
Phone
(517) 663-2671
Fax
(571) 663-2472
NPI assigned
Jan 8, 2007
Last updated
Mar 2, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2022

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

Authorized official

Name
Mr. Timothy J Johnson
Title
Chief Executive Officer
Phone
(517) 663-9474

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 230010 MI Primary

Addresses

Primary practice location

1500 S Main St
Eaton Rapids, MI 48827-1952

Mailing address

1500 S Main St
Eaton Rapids, MI 48827-1952
Phone (517) 663-2671

Other identifiers 1

IdentifierTypeStateIssuer
0B37608OtherMIBC QUICK CARE PIN NUMBER

Other names 1

  • Eaton Rapids Community Hospital Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070223000658 MI Part A Provider - Critical Access Hospital 5991692634 Receives reassigned benefits from 46 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Eaton Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730237165. Details of each certification follow.

Hospital certification: CCN 231324

Legal name
EATON RAPIDS MEDICAL CENTER
Doing business as
EATON RAPIDS MEDICAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Sep 1, 2005
Last certification
Jul 27, 2005
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
OtherNon-profit
Enrollment address
1500 S Main St
Eaton Rapids, MI 48827-0130

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Eaton Rapids Medical CenterCCN 231324 · 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
Kevin Waits DO5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Shari L Glynn Individual Corporate OfficerVP of Finance, Cfo Oct 1, 2010
W-2 Managing Employee Oct 1, 2010
Ashok K Gupta Individual Corporate Director Oct 1, 2007
Thomas a Kelly Individual Corporate Director Mar 1, 2011
Timothy J Johnson Individual Corporate OfficerPresident/Ceo Aug 1, 2010

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners & affiliated clinicians

Affiliated clinicians 103

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

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646179200000",
    "number": "1730237165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "488271952",
            "telephone_number": "517-663-2671",
            "fax_number": "571-663-2472"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 S MAIN ST",
            "city": "EATON RAPIDS",
            "state": "MI",
            "postal_code": "488271952",
            "telephone_number": "517-663-2671",
            "fax_number": "571-663-2472"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EATON RAPIDS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2022-03-02",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "517-663-9474",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "230010",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC QUICK CARE PIN NUMBER",
            "identifier": "0B37608",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eaton Rapids Community Hospital",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Eaton Rapids, MI

Sources for this page

Verify at the official NPI Registry.