NPIMap

Organization Active NPI

Three Rivers Health System, Inc

Doing business as Three Rivers Health Center for Family Medicine

  • Rural Health Clinic/Center
  • Three Rivers, MI
National Provider Identifier
1790144079
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Doing business as
Three Rivers Health Center for Family Medicine
Practice address
850 S Health Parkway
Three Rivers, MI 49093-8358
Phone
(269) 279-5240
Fax
(269) 273-9060
NPI assigned
Feb 16, 2016
Last updated
Sep 18, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTH SYSTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Authorized official

Name
Jeffery Costello
Title
Cfo
Phone
(574) 647-3460

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary
Family Medicine Physician 207Q00000X

Addresses

Primary practice location

850 S Health Parkway
Three Rivers, MI 49093-8358

Mailing address

3245 Health Dr Ste 100
Granger, IN 46530-1380

Other identifiers 1

IdentifierTypeStateIssuer
1790144079MedicaidMI

Other names 1

  • Three Rivers Health Center for Family Medicine Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140729001948 MI Part B Supplier - Clinic/Group Practice 8729245584 Receives reassigned benefits from 71 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portage, MI; Three Rivers, MI; White Pigeon, MI
O20190416000649 MI Part A Provider - Rural Health Clinic 8729245584 Practice locations: Three Rivers, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790144079. Details of each certification follow.

Rural health clinic certification: CCN 238718

Legal name
THREE RIVERS HEALTH SYSTEM INC
Doing business as
THREE RIVERS HEALTH CENTER FOR FAMILY MEDICINE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 6, 2019
Last certification
Jun 8, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
850 S Health Parkway
Three Rivers, MI 49093-8358
Related CCNs
230015

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

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 23

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

View all 23

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0920346Three Rivers Health for Family Medicine850 S Health Parkway, Three Rivers, MI 49093Certificate of waiverFeb 29, 2028

National Provider Directory

National Provider Directory
Tax ID family
Veera J Patel MD - Internal Medicine26 organizations share this tax ID, including this one
Part of
Veera J Patel MD - Internal Medicine

Other organizations with this tax ID 25

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

View all 25

Locations

711 S Health Parkway
Ste L7
Three Rivers, MI 49093
Phone (269) 273-9640

850 S Health Parkway
Three Rivers, MI 49093
Phone (269) 279-5240

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Irene Maffetone Individual W-2 Managing EmployeeContract Specialist Oct 1, 2021
Beacon Health System Inc Organization, South Bend, IN Corporation, Chain home office Operational/Managerial Control Oct 1, 2021
Jeffrey P Costello Individual Corporate DirectorCfo Oct 1, 2021
W-2 Managing EmployeeCfo Oct 1, 2021
Laurie Hines Individual Corporate OfficerBoard Member Apr 1, 2013
Richard Cordes Individual Corporate OfficerBoard Member Apr 1, 2013
Linda S Evans Individual Corporate DirectorBoard Member Jan 1, 2020
Hope Bailey Individual W-2 Managing EmployeeCco, Chief Clinical Officer Apr 1, 2013
Raymond Bendure Individual Corporate OfficerBoard Member Apr 1, 2013
Jessica L Puckett Individual Corporate OfficerBoard Member Apr 1, 2013

Owners & managing parties with NPI records 1

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Three Rivers HealthThree Rivers, MI, CCN 230015 Hospital 5% Or Greater Direct Ownership Interest (100%) Apr 1, 2013

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 21

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 21

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 2

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": "1455580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694995200000",
    "number": "1790144079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3245 HEALTH DR STE 100",
            "city": "GRANGER",
            "state": "IN",
            "postal_code": "465301380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 S HEALTH PARKWAY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490938358",
            "telephone_number": "269-279-5240",
            "fax_number": "269-273-9060"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HEALTH SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS HEALTH SYSTEM, INC",
        "enumeration_date": "2016-02-16",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-647-3460"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790144079",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Center for Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Three Rivers Health Center for Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Three Rivers, MI

Sources for this page

Verify at the official NPI Registry.