St. John Hospital and Medical Center

Primary specialty

Rehabilitation Hospital UnitTaxonomy code 273Y00000X

Legal business name

ST. JOHN HOSPITAL AND MEDICAL CENTER

Doing business as

St John North Shores Hospital

Practice address

26755 Ballard St
Harrison TWP, MI 48045-2419

Phone

(586) 465-5501

NPI assigned

Jan 23, 2006

Last updated

Oct 8, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Tomasine Marx

Title

VP Finance

Phone

(313) 343-7676

Specialties & licenses 1

Addresses

Other names 1

• St John North Shores Hospital Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801866942. Details of each certification follow.

• CCN 23T165 Hospital · Details

Hospital certification: CCN 23T165

Legal name

HENRY FORD HEALTH ST. JOHN HOSPITAL

Doing business as

HENRY FORD HEALTH - ST. JOHN HOSPITAL

Organization structure

CorporationNon-profit

Enrollment address

22101 Moross Rd
Detroit, MI 48236-2148
Hospital Rehabilitation Unit

Hospital subgroups

Acute care, Rehabilitation unit

Related certifications (CCN) 1

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

• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168

  Unit of hospital

  Provider of Services

Other NPIs on the same Medicare enrollment 2

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

• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • Rehabilitation Hospital Unit
  • Detroit, MI
  • NPI 1023335544

  O20101230000745

  Same enrollment
• Henry Ford Health St. John Hospital

  dba St John Hospital and Medical Center

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1023088168

  O20101230000745

  Same enrollment

Listed as

Ascension St John HospitalCCN 23T165 · All quality measures

Ownership

Non-profit

Certified

Jul 1, 2010

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

• Beachside Dialysis LLC

  dba Harper Woods Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Harper Woods, MI
  • NPI 1780953604

  Member Of

  NPD member
• Eastside Associates, LLC

  dba Eastside Endoscopy Center

  • Endoscopy Clinic/Center
  • Saint Clair Shores, MI
  • NPI 1407847676

  Member Of

  NPD member
• Henry Ford Health Eastwood Behavioral Health

  dba Eastwood Clinics

  • Social Worker
  • Clinton Township, MI
  • NPI 1396787701

  Member Of

  NPD member
• North Macomb MRT Center LLC

  • Radiation Oncology Physician
  • Macomb, MI
  • NPI 1053575118

  Member Of

  NPD member
• Macomb Magnetic Resonance Imaging Center Inc

  dba Macomb MRI Center

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1235133141

  Member Of

  NPD member
• Wayne Macomb Diagnostic Imaging Center Inc

  dba Wayne Macomb MRI Center

  • Diagnostic Radiology Physician
  • Chicago, IL
  • NPI 1326042235

  Member Of

  NPD member

All disclosed owners & managing parties 30

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

Owners & managing parties with NPI records 2

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

• Farzan Siddiqui, M.D., PH.D.

  • Radiation Oncology Physician
  • Detroit, MI
  • NPI 1922217793

  Corporate Director

  CMS ownership
• Lisa Fitzpatrick, MD, MPH

  • Internal Medicine Physician
  • Washington, DC
  • NPI 1588664056

  Corporate Director

  CMS ownership

Affiliated clinicians 3

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

• Raymond T Bauer, MD

  • Physical Medicine & Rehabilitation Physician
  • Saint Clair Shores, MI
  • NPI 1083607691

  Inpatient rehabilitation facility

  Care Compare affiliation
• Mohamed Bosher Mansour, MD

  • Pulmonary Disease Physician
  • Saint Clair Shores, MI
  • NPI 1710332606

  Inpatient rehabilitation facility

  Care Compare affiliation
• Bhavik Patel, DPM

  • Foot & Ankle Surgery Podiatrist
  • Saint Clair Shores, MI
  • NPI 1790300978

  Inpatient rehabilitation facility

  Care Compare affiliation

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

{
    "created_epoch": "1137974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349654400000",
    "number": "1801866942",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28000 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480922468",
            "telephone_number": "586-753-0275",
            "fax_number": "586-753-0286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26755 BALLARD ST",
            "city": "HARRISON TWP",
            "state": "MI",
            "postal_code": "480452419",
            "telephone_number": "586-465-5501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOHN HOSPITAL AND MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-23",
        "last_updated": "2012-10-08",
        "status": "A",
        "authorized_official_last_name": "MARX",
        "authorized_official_first_name": "TOMASINE",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "313-343-7676",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "273Y00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Unit",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St John North Shores Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Serenity Now
• Kathleen Connie Shaw, LLMSW
• Karen Sogge, RN
• Spi Senior Living
• St John Harrison Township Urgent Care
• St. John North Shores Emergency Physicians, P.C.
• Makenzie Thimm, RN
• Rhiannon Rose Vanreyendam, PA-C
• Samantha Varriale
• We Care Home Inc.

• Rehabilitation Hospital Unit in Harrison TWP, MI
• Providers in Harrison TWP, MI by specialty
• Rehabilitation Hospital Unit in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.

Verify at the official NPI Registry.