NPIMap

Organization Active NPI

Madison Community Hospital, Inc.

  • Psychiatric Hospital
  • Detroit, MI
National Provider Identifier
1972743425
Registry record updated Feb 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric HospitalTaxonomy code 283Q00000X
Legal business name
MADISON COMMUNITY HOSPITAL, INC.
Practice address
5555 Conner St
Detroit, MI 48213-3448
Phone
(313) 344-7730
NPI assigned
Feb 24, 2009
Organization subpart
Yes
Parent organization
MADISON COMMUNITY HOSPITAL, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 2, 2010

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

Authorized official

Name
Ryan Gunabalan
Title
Ceo
Phone
(586) 261-2266

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric Hospital 283Q00000X Primary

Addresses

Primary practice location

5555 Conner St
Detroit, MI 48213-3448

Mailing address

5555 Conner St
Detroit, MI 48213-3448
Phone (313) 344-7730

Other names 1

  • Samaritan Behavioral Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100127000270 MI Part A Provider - Hospital 3971571704 Practice locations: Detroit, MI

Hospital certification: CCN 234040

Legal name
MADISON COMMUNITY HOSPITAL INC.
Doing business as
SAMARITAN BEHAVIORAL CENTER
Certification status
Active
Provider type (POS)
Hospital – Psychiatric
Participating since
Jul 14, 2010
Last certification
Jul 22, 2015
Beds
55
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
5555 Conner Avenue
Suite 3 North
Detroit, MI 48213-3487
Hospital Psychiatric Unit
Hospital subgroups
Psychiatric, Psychiatric unit

Hospital certification: CCN 230147

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
MERCY HOSPITAL
Certification status
Terminated Voluntary: merger or closure, Feb 1, 2000
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jul 19, 1990
Beds
189
Ownership / control type
Church
Facility address
5555 Conner Avenue
Detroit, MI 48213

Care Compare: Hospital

Medicare Care Compare
Listed as
Samaritan Behavioral CenterCCN 234040
Type
Psychiatric
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

National Provider Directory

National Provider Directory
Tax ID family
Madison Community Hospital5 organizations share this tax ID, including this one
Part of
Madison Community Hospital

Other organizations with this tax ID 4

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

Locations

5555 Conner St
Ste 3N
Detroit, MI 48213
Phone (313) 344-7730

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
T & G Corporation Inc Organization, Warren, MI Corporation Operational/Managerial Control Apr 1, 2009
Ryan Gunabalan Individual Corporate OfficerChief Executive Officer Oct 1, 2015 100%
Corporate Director Apr 1, 2009
W-2 Managing EmployeeChief Executive Officer Oct 1, 2015 100%
Operational/Managerial ControlChief Executive Officer Oct 1, 2015 100%
Robert Clemente Individual Corporate DirectorBoard of Director Jan 1, 2009
Laurie Sall Individual Corporate DirectorBoard of Director Jan 1, 2012
Timothy Dengel Individual Corporate DirectorBoard of Director Jan 1, 2009

Owners & managing parties with NPI records 1

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

Facilities with the same owner 1

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 2

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

NPI Registry JSON

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

{
    "created_epoch": "1235433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265068800000",
    "number": "1972743425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133448",
            "telephone_number": "313-344-7730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5555 CONNER ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482133448",
            "telephone_number": "313-344-7730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON COMMUNITY HOSPITAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MADISON COMMUNITY HOSPITAL, INC.",
        "enumeration_date": "2009-02-24",
        "last_updated": "2010-02-02",
        "status": "A",
        "authorized_official_last_name": "GUNABALAN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "586-261-2266"
    },
    "taxonomies": [
        {
            "code": "283Q00000X",
            "taxonomy_group": "",
            "desc": "Psychiatric Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Samaritan Behavioral Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit, MI

Sources for this page

Verify at the official NPI Registry.