NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital

Doing business as Henry Ford Allegiance Health

  • Family Medicine Physician
  • Jackson, MI
National Provider Identifier
1962953034
Registry record updated Oct 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1060000044 Issued in MI
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL
Doing business as
Henry Ford Allegiance Health
Henry Ford Jackson Health
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-7843
NPI assigned
Oct 24, 2016
Last updated
Oct 20, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2026

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

Authorized official

Name
Kimberly Cebalt
Title
Director
Phone
(313) 874-6764

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 1060000044 MI Primary
Sports Medicine (Family Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207QS0010X

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

PO Box 670884
Detroit, MI 48267-0884
Phone (800) 999-5829

Other names 2

  • Henry Ford Allegiance Health Doing business as
  • Henry Ford Jackson Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031212000691 MI Part B Supplier - Clinic/Group Practice 0244136067 Receives reassigned benefits from 485 practitioners
This NPI is an additional NPI on the enrollment
Practice locations: Jackson, MI; Albion, MI; Jonesville, MI; Leslie, MI; Marshall, MI; Mason, MI; Onsted, MI; Spring Arbor, MI…

National Provider Directory

National Provider Directory
Tax ID family
Foote Memorial Physicia104 organizations share this tax ID, including this one
Part of
Henry for Health Sys

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

153 Wamplers Lake Rd
Brooklyn, MI 49230
Phone (517) 205-2105

1201 E Michigan Ave
Ste 300
Jackson, MI 49201
Phone (517) 205-1431

Practitioners & affiliated clinicians

Practitioners 31

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 31

NPI Registry JSON

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

{
    "created_epoch": "1477267200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792454400000",
    "number": "1962953034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 670884",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482670884",
            "telephone_number": "800-999-5829",
            "fax_number": "248-641-4840"
        },
        {
            "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": "492011753",
            "telephone_number": "517-205-7843"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-24",
        "last_updated": "2026-10-20",
        "certification_date": "2026-10-20",
        "status": "A",
        "authorized_official_last_name": "CEBALT",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "313-874-6764"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "1060000044",
            "primary": true
        },
        {
            "code": "207QS0010X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine, Sports Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Henry Ford Jackson Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2026; 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.