NPIMap

Organization Active NPI

Wa Foote Memorial Hospital, Inc

  • Internal Medicine Physician
  • Jackson, MI
National Provider Identifier
1831123728
Registry record updated Mar 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
WA FOOTE MEMORIAL HOSPITAL, INC
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 788-4800
NPI assigned
Jul 10, 2006
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 5

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X MI Primary
Cardiovascular Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RC0000X MI
Endocrinology, Diabetes & Metabolism PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RE0101X MI
Nephrology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RN0300X MI
Pulmonary Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RP1001X 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
700C860070OtherMIBCBSM/MD/DO

Other names 1

  • Henry Ford Allegiance Health Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031212000691 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 485 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI; Albion, MI; Jonesville, MI; Leslie, MI; Marshall, MI; Mason, MI; Onsted, MI; Spring Arbor, MI…
O20031212000875 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 58 practitioners
2 other NPIs 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 2

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

National Provider Directory

National Provider Directory
Part of
Foote Emerg Phys

Member of 1

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

Locations

205 N East Ave
Fl 1
Jackson, MI 49201

216 Olds St
#R
Jonesville, MI 49250

216 Olds St
Jonesville, MI 49250
Phone (517) 849-7100

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 64

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 64

NPI Registry JSON

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1831123728",
    "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": "2006-07-10",
        "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": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RP1001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Pulmonary Disease",
            "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/MD/DO",
            "identifier": "700C860070",
            "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.