NPIMap

Organization Active NPI

Packard Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Ann Arbor, MI
National Provider Identifier
1841687589
Registry record updated Oct 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
PACKARD HEALTH, INC.
Practice address
1915 Pauline Blvd
Ann Arbor, MI 48103-5001
Phone
(734) 926-4900
Fax
(734) 926-4901
NPI assigned
Apr 21, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2022

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

Authorized official

Name
Todd Montrief, CPA
Title
Cfo
Phone
(734) 926-4935

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

1915 Pauline Blvd
Ann Arbor, MI 48103-5001

Mailing address

5200 Venture Dr
Ann Arbor, MI 48108-9561
Phone (734) 926-4935

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150313000358 MI Part A Provider - Federally Qualified Health Center (FQHC) 6204876113 1 other NPI on this enrollment
Practice locations: Ann Arbor, MI

Federally qualified health center certification: CCN 231050

Legal name
PACKARD HEALTH INC
Doing business as
PACKARD HEALTH INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 16, 2015
Last certification
Mar 16, 2015
Ownership / control type
For profit – partnership
Organization structure
CorporationNon-profit
Enrollment address
1915 Pauline Blvd
Ann Arbor, MI 48103-5001

Other NPIs with the same Medicare PAC ID 6

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.

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
23D2007506Packard Health1915 Pauline Blvd, Ann Arbor, MI 48103Provider-performed microscopyMar 28, 2027

National Provider Directory

National Provider Directory
Tax ID family
Packard Health Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
Raymond J Rion Individual Corporate DirectorExecutive Director Nov 16, 2012
David Hoffman Individual Corporate OfficerCfo Jan 9, 2023
W-2 Managing EmployeeCfo Jan 9, 2023

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
Packard Health IncYpsilanti, MI, CCN C71021 Federally qualified health center 5% Or Greater Direct Ownership Interest (100%) Oct 12, 1989

Owned or controlled facilities with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 6

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

NPI Registry JSON

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

{
    "created_epoch": "1429574400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1664928000000",
    "number": "1841687589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 VENTURE DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481089561",
            "telephone_number": "734-926-4935",
            "fax_number": "734-773-1833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1915 PAULINE BLVD",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481035001",
            "telephone_number": "734-926-4900",
            "fax_number": "734-926-4901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PACKARD HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-21",
        "last_updated": "2022-10-05",
        "certification_date": "2022-10-05",
        "status": "A",
        "authorized_official_last_name": "MONTRIEF",
        "authorized_official_first_name": "TODD",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "734-926-4935",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

Verify at the official NPI Registry.