NPIMap

W.a. Foote Memorial Hospital, Inc

Organization Active NPI Psychiatry Physician · Jackson, MI

NPI 1912445677 · NPPES record last updated Mar 6, 2024

Key facts

NPI
1912445677
Entity type
Organization (NPI type 2)
Primary specialty
Psychiatry Physician 2084P0800X
License
1060000044 (MI)
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL, INC
Practice address
205 N. East Ave
Jackson, MI 49201
Phone
(517) 841-7843
Fax
(517) 841-7419
NPI assigned
Feb 2, 2017
Organization subpart
Yes
Parent organization (as reported)
HENRY FORD ALLEGIANCE HEALTH GROUP

Authorized official

Name
Mark Smith, MD
Title
SVP - Cmo, Ceo - Hfamg
Phone
(517) 205-6407

Other NPIs on the same Medicare enrollment 3

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

Corporate family (same tax ID) 21

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

Practitioners 28

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

View all 28

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in MI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031215000624 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 101 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI
O20040825001226 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 14 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI

National Provider Directory

Tax ID family
Foote Emerg Phys (104 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0800X 1060000044 MI Yes

Addresses

Primary practice location

205 N. East Ave
Jackson, MI 49201

Mailing address

PO Box 67000
Department 272801
Detroit, MI 48267
Phone (517) 841-7843

Other identifiers

IdentifierTypeStateIssuer
1326078866MedicaidMI

Other names

  • Henry Ford Allegiance Health Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 6, 2024.

{
    "created_epoch": "1485993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709683200000",
    "number": "1912445677",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48267",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N. EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENRY FORD ALLEGIANCE HEALTH GROUP",
        "enumeration_date": "2017-02-02",
        "last_updated": "2024-03-06",
        "certification_date": "2024-03-06",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "SVP - CMO, CEO - HFAMG",
        "authorized_official_telephone_number": "517-205-6407",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "1060000044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1326078866",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

All providers in Jackson, MI · Psychiatry Physician in Michigan

Sources for this page

Verify at the official NPI Registry.