NPIMap

Organization Active NPI

Sparrow Ionia Hospital

Doing business as Sparrow Ionia Hospital General Surgery

  • Surgery Physician
  • Ionia, MI
National Provider Identifier
1891879029
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101014682 Issued in MI
Legal business name
SPARROW IONIA HOSPITAL
Doing business as
Sparrow Ionia Hospital General Surgery
University of Michigan Health-Sparrow Ionia General Surgery
Practice address
3565 S State Rd
Ionia, MI 48846-9416
Phone
(616) 523-1494
Fax
(616) 523-1496
NPI assigned
Oct 24, 2006
Last updated
Mar 11, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
SPARROW HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 11, 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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 4301038199 MI
Surgery Physician 208600000X 4301076427 MI
Surgery Physician 208600000X 5101014682 MI Primary

Addresses

Primary practice location

3565 S State Rd
Ionia, MI 48846-9416

Mailing address

8175 Reliable Pkwy
Chicago, IL 60686-0081
Phone (517) 364-6253

Other identifiers 2

IdentifierTypeStateIssuer
0C410380OtherMIBCBS MI
1891879029MedicaidMI

Other names 2

  • SPARROW IONIA HOSPITAL GENERAL SURGERY Doing business as
  • University of Michigan Health-Sparrow Ionia General Surgery Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031230000664 MI Part B Supplier - Clinic/Group Practice 0042118887 Receives reassigned benefits from 366 practitioners
12 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Carson City, MI; Ionia, MI; Portland, MI; Saint Johns, MI

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Part of
Sparrow Health System

Practitioners & affiliated clinicians

Practitioners 22

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.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1891879029",
    "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": "517-364-6253",
            "fax_number": "517-364-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3565 S STATE RD",
            "city": "IONIA",
            "state": "MI",
            "postal_code": "488469416",
            "telephone_number": "616-523-1494",
            "fax_number": "616-523-1496"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPARROW IONIA HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPARROW HEALTH SYSTEM",
        "enumeration_date": "2006-10-24",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "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": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "MI",
            "license": "4301038199",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301076427",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101014682",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI",
            "identifier": "0C410380",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1891879029",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPARROW IONIA HOSPITAL GENERAL SURGERY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "University of Michigan Health-Sparrow Ionia General Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ionia, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.