NPIMap

Organization Active NPI

Mercy Memorial Hospital Corporation

  • Endocrinology, Diabetes & Metabolism Physician
  • Monroe, MI
National Provider Identifier
1861636540
Registry record updated Apr 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
4301081240 Issued in MI
Legal business name
MERCY MEMORIAL HOSPITAL CORPORATION
Practice address
718 N Macomb St
Monroe, MI 48162-7815
Phone
(734) 240-8840
Fax
(734) 240-4450
NPI assigned
Apr 27, 2009
Last updated
Apr 27, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2009

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

Authorized official

Name
Mrs. Annette Phillips
Title
Ceo
Phone
(734) 240-8840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 4301081240 MI Primary

Addresses

Primary practice location

718 N Macomb St
Monroe, MI 48162-7815

Mailing address

718 N Macomb St
Monroe, MI 48162-7815
Phone (734) 240-8840

Other identifiers 1

IdentifierTypeStateIssuer
080E812180OtherMIBLUE CROSS

Other names 1

  • MOOSA Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061212000299 MI Part B Supplier - Clinic/Group Practice 7012811615 Receives reassigned benefits from 60 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Temperance, MI; Newport, MI; Monroe, MI; Luna Pier, MI; Dundee, MI; Carleton, MI

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
Tax ID family
Mercy Memorial Hosp10 organizations share this tax ID, including this one
Part of
Mercy Memorial Hosp

Other organizations with this tax ID 9

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

Practitioners & affiliated clinicians

Practitioners 2

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": "1240790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1240790400000",
    "number": "1861636540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "718 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481627815",
            "telephone_number": "734-240-8840",
            "fax_number": "734-240-4450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "718 N MACOMB ST",
            "city": "MONROE",
            "state": "MI",
            "postal_code": "481627815",
            "telephone_number": "734-240-8840",
            "fax_number": "734-240-4450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERCY MEMORIAL HOSPITAL CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOSPITAL",
        "enumeration_date": "2009-04-27",
        "last_updated": "2009-04-27",
        "status": "A",
        "authorized_official_last_name": "PHILLIPS",
        "authorized_official_first_name": "ANNETTE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "734-240-8840",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "4301081240",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "080E812180",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOOSA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Monroe, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; 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.