NPIMap

Organization Active NPI

Wa Foote Memorial Hospital, Inc

Doing business as Henry Ford Allegiance Health

  • Audiologist
  • Jackson, MI
National Provider Identifier
1811921968
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
Legal business name
WA FOOTE MEMORIAL HOSPITAL, INC
Doing business as
Henry Ford Allegiance Health
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4800
NPI assigned
Jul 11, 2006
Last updated
Mar 6, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WA 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, CFO
Title
SVP. Cmo
Phone
(517) 205-6407

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology Physician 207Y00000X
Audiologist 231H00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X MI

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) 841-7482

Other identifiers 2

IdentifierTypeStateIssuer
CC5829OtherMIRR MEDICARE
540C876160OtherMIBCBSM/AUDIOLOGIST

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
O20040421001606 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Jackson, MI

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Wa Foote Memorial Hospi104 organizations share this tax ID, including this one
Part of
Wa Foote Memorial Hospi

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

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

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 12

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": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1811921968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482672728",
            "telephone_number": "517-841-7482",
            "fax_number": "517-841-7476"
        },
        {
            "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": "517-788-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WA FOOTE MEMORIAL HOSPITAL, INC",
        "enumeration_date": "2006-07-11",
        "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",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "CC5829",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM/AUDIOLOGIST",
            "identifier": "540C876160",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "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.