NPIMap

Organization Active NPI

Sparrow Eaton Hospital

Doing business as Grand Ledge Public Schools Health Center

  • Adolescent Medicine (Family Medicine) Physician
  • Grand Ledge, MI
National Provider Identifier
1841079787
Registry record updated Nov 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adolescent Medicine (Family Medicine) PhysicianTaxonomy code 207QA0000X
Legal business name
SPARROW EATON HOSPITAL
Doing business as
Grand Ledge Public Schools Health Center
Practice address
820 Spring St Ste 100
Grand Ledge, MI 48837-1834
Phone
(517) 925-5590
Fax
(517) 925-5590
NPI assigned
Sep 28, 2023
Last updated
Nov 8, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARROW HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 8, 2024

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

Authorized official

Name
Misty Gunter Russian
Title
Supervisor, Provider Enrollment
Phone
(517) 253-6308

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X NU
Adolescent Medicine (Family Medicine) Physician 207QA0000X NU Primary

Addresses

Primary practice location

820 Spring St Ste 100
Grand Ledge, MI 48837-1834

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 253-6320

Other names 1

  • Grand Ledge Public Schools Health Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040213000368 MI Part B Supplier - Clinic/Group Practice 0042103509 Receives reassigned benefits from 152 practitioners
11 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lansing, MI; Charlotte, MI; Olivet, MI; Grand Ledge, MI; Eaton Rapids, MI; East Lansing, MI

Other NPIs on the same Medicare enrollment 9

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

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
23D2297944Grand Ledge Public Schools Health Center820 Spring Street Door 20, Grand Ledge, MI 48837Certificate of waiverJan 24, 2028

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Practitioners & affiliated clinicians

Practitioners 4

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": "1695859200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731024000000",
    "number": "1841079787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8175 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860081",
            "telephone_number": "517-253-6320",
            "fax_number": "517-253-6321"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 SPRING ST STE 100",
            "city": "GRAND LEDGE",
            "state": "MI",
            "postal_code": "488371834",
            "telephone_number": "517-925-5590",
            "fax_number": "517-925-5590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARROW EATON HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2023-09-28",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A",
        "authorized_official_last_name": "RUSSIAN",
        "authorized_official_first_name": "MISTY",
        "authorized_official_middle_name": "GUNTER",
        "authorized_official_title_or_position": "SUPERVISOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "517-253-6308"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207QA0000X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Ledge Public Schools Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Ledge, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.