NPIMap

Organization Active NPI

Three Rivers Health System Inc

Doing business as Three Rivers Health Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Three Rivers, MI
National Provider Identifier
1891054987
Registry record updated Nov 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
750020 Issued in MI
Legal business name
THREE RIVERS HEALTH SYSTEM INC
Doing business as
Three Rivers Health Endocrinology
Practice address
715 S Health Pkwy
Three Rivers, MI 49093-8352
Phone
(269) 273-8471
Fax
(269) 273-9680
NPI assigned
May 9, 2012
Last updated
Nov 25, 2014By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTH SYSTEM INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 25, 2014

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

Authorized official

Name
William Russell
Title
Ceo/President
Phone
(269) 273-9601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 750020 MI Primary

Addresses

Primary practice location

715 S Health Pkwy
Three Rivers, MI 49093-8352

Mailing address

715 S Health Pkwy
Three Rivers, MI 49093-8352
Phone (269) 273-8471

Other names 1

  • Three Rivers Health Endocrinology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140729001948 MI Part B Supplier - Clinic/Group Practice 8729245584 Receives reassigned benefits from 71 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portage, MI; Three Rivers, MI; White Pigeon, MI

Other NPIs on the same Medicare enrollment 23

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

View all 23

National Provider Directory

National Provider Directory
Part of
Three Rivers Inc

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.

NPI Registry JSON

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

{
    "created_epoch": "1336521600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416873600000",
    "number": "1891054987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 S HEALTH PKWY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490938352",
            "telephone_number": "269-273-8471",
            "fax_number": "269-273-9680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S HEALTH PKWY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490938352",
            "telephone_number": "269-273-8471",
            "fax_number": "269-273-9680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HEALTH SYSTEM INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS HEALTH SYSTEM INC",
        "enumeration_date": "2012-05-09",
        "last_updated": "2014-11-25",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-273-9601"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "750020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Endocrinology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Three Rivers, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2014; 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.