NPIMap

Organization Active NPI

Chelsea Community Hospital

  • Psychiatry Physician
  • Chelsea, MI
National Provider Identifier
1912947409
Registry record updated Nov 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
Legal business name
CHELSEA COMMUNITY HOSPITAL
Practice address
775 S Main St
Chelsea, MI 48118-1370
Phone
(734) 475-6914
Fax
(734) 475-7549
NPI assigned
Jun 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2017

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

Authorized official

Name
Michael Gusho
Title
Regional Cfo SE Mi
Phone
(734) 398-0642

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Psychiatry PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084P0800X Primary
Surgical Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363AS0400X

Addresses

Primary practice location

775 S Main St
Chelsea, MI 48118-1370

Mailing address

34505 W 12 Mile Rd Ste 200
Farmington Hills, MI 48331-3286
Phone (743) 343-3922

Other identifiers 1

IdentifierTypeStateIssuer
260H161260OtherMIBCBCM GROUP PIN

Other names 1

  • St. Joseph Mercy Chelsea Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040119000004 MI Part B Supplier - Clinic/Group Practice 0648171074 Receives reassigned benefits from 179 practitioners
5 other NPIs on this enrollment
Practice locations: Chelsea, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 183

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

View all 183

NPI Registry JSON

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

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1510099200000",
    "number": "1912947409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34505 W 12 MILE RD STE 200",
            "city": "FARMINGTON HILLS",
            "state": "MI",
            "postal_code": "483313286",
            "telephone_number": "743-343-3922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "775 S MAIN ST",
            "city": "CHELSEA",
            "state": "MI",
            "postal_code": "481181370",
            "telephone_number": "734-475-6914",
            "fax_number": "734-475-7549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHELSEA COMMUNITY HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2017-11-08",
        "status": "A",
        "authorized_official_last_name": "GUSHO",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "REGIONAL CFO SE MI",
        "authorized_official_telephone_number": "734-398-0642"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBCM GROUP PIN",
            "identifier": "260H161260",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Joseph Mercy Chelsea",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Chelsea, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2017; 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.