NPIMap

Organization Active NPI

Hillsdale Community Health Center

  • Rural Health Clinic/Center
  • Hillsdale, MI
National Provider Identifier
1952951014
Registry record updated Sep 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HILLSDALE COMMUNITY HEALTH CENTER
Practice address
240 W Carleton Rd
Hillsdale, MI 49242-5034
Phone
(517) 437-7040
NPI assigned
Sep 19, 2019
Last updated
Sep 19, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2019

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

Authorized official

Name
Mark Gross, CFO
Title
Chief Financial Officer
Phone
(517) 437-5232

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

240 W Carleton Rd
Hillsdale, MI 49242-5034

Mailing address

240 W Carleton Rd
Hillsdale, MI 49242-5034
Phone (517) 437-7040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040805000518 MI Part B Supplier - Clinic/Group Practice 7214846260 Receives reassigned benefits from 121 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Hillsdale, MI; Reading, MI
O20191115002323 MI Part A Provider - Rural Health Clinic 7214846260 Practice locations: Hillsdale, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952951014. Details of each certification follow.

Rural health clinic certification: CCN 238725

Legal name
HILLSDALE COMMUNITY HEALTH CENTER
Doing business as
HILLSDALE HEALTH & WELLNESS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 2, 2020
Last certification
Oct 2, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
240 W Carleton Rd
Hillsdale, MI 49242-5034
Related CCNs
230037

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

Other NPIs on the same Medicare enrollment 4

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2061291Hillsdale Health and Wellness240 W Carleton Road, Hillsdale, MI 49242Certificate of waiverJun 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Hillsdale Community Center6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

Locations

168 S Howell St
Fl 3
Hillsdale, MI 49242

183 Hillsdale St
Hillsdale, MI 49242

451 Hidden Meadows Dr
Ste 120
Hillsdale, MI 49242
Phone (517) 437-0010

Ownership & related parties

All disclosed owners & managing parties 15

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Mark a Gross Individual Corporate OfficerCfo Apr 2, 2018
David D Gossage Individual Corporate DirectorBoard Member Jan 1, 2010
Nichole Kristine Ellis Individual Corporate DirectorBoard Member - Ex Officio Jan 1, 2017
Gregory Bailey Individual Corporate DirectorBoard Member Jan 1, 1996
Robert Henthorne Individual Corporate DirectorBoard Member Oct 1, 2009
Karlye Horton Individual Corporate DirectorBoard Member Nov 1, 2018
Craig Connor Individual Corporate DirectorBoard Member Jan 1, 2008
Lindsey Crouch Individual W-2 Managing EmployeeDirector of Outpatient Clinics Jun 2, 2025
Shea Dow Individual Corporate DirectorBoard Member Jan 1, 2024
Kimberly Blythe Individual Corporate DirectorBoard Member Dec 1, 2015
Hillsdale Community Health Center Organization, Hillsdale, MI Corporation 5% Or Greater Direct Ownership Interest Jul 18, 2019 100%
Jeremiah Hodshire Individual Corporate DirectorPresident and Ceo May 1, 2021
Diane Philipp Individual Corporate DirectorBoard Member Jan 1, 2009
Susan Mary Smith Individual Corporate DirectorBoard Member Feb 1, 2021
Richard Moore Individual Corporate DirectorBoard Member Oct 1, 2011

Owners & managing parties with NPI records 8

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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": "1568851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568851200000",
    "number": "1952951014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "240 W CARLETON RD",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492425034",
            "telephone_number": "517-437-7040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 W CARLETON RD",
            "city": "HILLSDALE",
            "state": "MI",
            "postal_code": "492425034",
            "telephone_number": "517-437-7040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSDALE COMMUNITY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-19",
        "last_updated": "2019-09-19",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "517-437-5232",
        "authorized_official_credential": "CFO"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hillsdale, MI

Sources for this page

Verify at the official NPI Registry.