NPIMap

Organization Active NPI

Three Rivers Health System, Inc

Doing business as Three Rivers Health Sleep Clinic

  • Sleep Medicine (Internal Medicine) Physician
  • Three Rivers, MI
National Provider Identifier
1902163322
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
License
750020 Issued in MI
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Doing business as
Three Rivers Health Sleep Clinic
Practice address
701 S Health Pkwy
Three Rivers, MI 49093-8352
Phone
(269) 278-1145
NPI assigned
Apr 23, 2012
Last updated
Jun 23, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTH SSYTEM, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Authorized official

Name
Jeffery Costello
Title
Cfo
Phone
(574) 647-3460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X 750020 MI Primary

Addresses

Primary practice location

701 S Health Pkwy
Three Rivers, MI 49093-8352

Mailing address

711 S Health Pkwy
Suite L-7
Three Rivers, MI 49093-9387
Phone (269) 273-9640

Other names 1

  • Three Rivers Health Sleep Clinic 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
Tax ID family
Three Rivers Health System26 organizations share this tax ID, including this one
Part of
Three Rivers Health System

Other organizations with this tax ID 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1655942400000",
    "number": "1902163322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "711 S HEALTH PKWY",
            "address_2": "SUITE L-7",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490939387",
            "telephone_number": "269-273-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 S HEALTH PKWY",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490938352",
            "telephone_number": "269-278-1145"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HEALTH SYSTEM, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS HEALTH SSYTEM, INC",
        "enumeration_date": "2012-04-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A",
        "authorized_official_last_name": "COSTELLO",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "574-647-3460"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "750020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Sleep Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Three Rivers Health Sleep Clinic",
            "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 Jun 23, 2022; 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.