MADISON COMMUNITY HOSPITAL INC (NPI# 1699234153) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699234153 |
| Entity Type | Organization |
| Organization Name | MADISON COMMUNITY HOSPITAL INC |
| Other Organization Name | SAMARITAN BEHAVIORAL CENTER - PROFESSIONAL BILLING |
| Practice Address |
5555 Conner St Detroit MI 48213-3448 |
| Practice Telephone | 3133447730 |
| Mailing Telephone | 3133447730 |
| Enumeration Date | 2019-03-14 |
| Last Update Date | 2019-05-29 |
| Authorized Official Name | RYAN GUNABALAN (CEO) |
| Authorized Official Telephone | 5862612266 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Samaritan Behavioral Center - Professional Billing | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376978437 | Madison Community Hospital Inc | Clinical Medical Laboratory | 17200 E 10 Mile Rd, Suite 250, Eastpointe, MI 48021-3355 | 2013-09-09 |
| 1962664060 | Madison Community Hospital Inc | Pharmacy | 4050 E 12 Mile Rd, Warren, MI 48092-2534 | 2008-06-30 |
| 1790962157 | Madison Community Hospital Inc | Pharmacy | 4050 E 12 Mile Rd, Warren, MI 48092-2534 | 2008-01-29 |
| Street Address |
5555 CONNER ST |
| City | DETROIT |
| State | MI |
| Zip Code | 48213-3448 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245237551 | Mary L Serowoky | Nurse Practitioner | 5555 Conner St, St 2691, Detroit, MI 48213-3448 | 2005-06-30 |
| 1902422751 | Dhaara Antani | Dietitian, Registered | 5555 Conner St, Detroit, MI 48213-3448 | 2020-06-17 |
| 1164066643 | Bethany J. Howard | Case Manager/Care Coordinator | 5555 Conner St, Detroit, MI 48213-3448 | 2019-10-29 |
| 1700357563 | Ashley Henninger | Speech-Language Pathologist | 5555 Conner St, Detroit, MI 48213-3448 | 2018-12-05 |
| 1720564651 | Metropolitan Detroit Center for Independent Living | Case Management | 5555 Conner St, Detroit, MI 48213-3448 | 2018-07-13 |
| 1386158962 | Sharon Diane Fowler | Counselor | 5555 Conner St, Detroit, MI 48213-3448 | 2017-11-19 |
| 1346605847 | Shannon Crumbley | In Home Supportive Care | 5555 Conner St, 2079c, Detroit, MI 48213-3448 | 2015-12-28 |
| 1083080121 | Sonya Shelman | Social Worker | 5555 Conner St, Detroit, MI 48213-3448 | 2015-08-12 |
| 1629450960 | Marquetta Turner | Social Worker | 5555 Conner St, Suite 1038, Detroit, MI 48213-3448 | 2015-06-23 |
| 1912317975 | Emerging Industries Training Institute, Inc. | Non-emergency Medical Transport (VAN) | 5555 Conner St, Suite 1600, Detroit, MI 48213-3448 | 2014-04-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215540430 | Sheronda Lanetta Blackmon | Licensed Practical Nurse | 13929 Harper Ave., Detroit, MI 48213 | 2020-08-27 |
| 1073049144 | Cheryl Williams | Community Health Worker | 13929 Chalmers Ave., Detroit, MI 48213 | 2017-05-10 |
| 1164963401 | Smile Fresh Detroit PC | Dentist | 7230 Gratiot Avenue, Detroit, MI 48213 | 2017-03-20 |
| 1255887899 | Jay Washington | Behavioral Analyst | 9146 Haper, Detroit, MI 48213 | 2016-09-01 |
| 1396129532 | Sarietha King | Home Health | 14639 Manistique, Detroit, MI 48213 | 2015-07-17 |
| 1366823197 | Royal Treatment Mental Health Systems, LLC | Counselor | 5555 Corner Avenue, Detroit, MI 48213 | 2015-06-17 |
| 1477956779 | Monique Powell | Student in an Organized Health Care Education/Training Program | 5801 Lakeview S.t, Detroit, MI 48213 | 2014-09-30 |
| 1629339163 | Samuel Joseph Farmer | Counselor | 10100 Harper Ave., Detroit, MI 48213 | 2012-05-31 |
| 1609164755 | Vernon Keith Johnson | Social Worker | 20203 Kelly Road, Detroit, MI 48213 | 2011-07-11 |
| 1023312790 | Davenport Quality Home Care LLC | Home Health | 5027 Maxwell, Detroit, MI 48213 | 2011-01-10 |
| Find all providers in zip 48213 | ||||
| Taxonomy Code | 363L00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certified specialty. (2) A registered nurse who has completed additional training beyond basic nursing education and who provides primary health care services in accordance with state nurse practice laws or statutes. Tasks performed by nurse practitioners vary with practice requirements mandated by geographic, political, economic, and social factors. Nurse practitioner specialists include, but are not limited to, family nurse practitioners, gerontological nurse practitioners, pediatric nurse practitioners, obstetric-gynecologic nurse practitioners, and school nurse practitioners. |
| Notes: Source: (1) American Nurses’ Association, American Nurses Credentialing Center, 1996 Certification Catalogue. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 549. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629616511 | Nursing Practice Corporation | Nurse Practitioner | 1550 Taylor St, Detroit, MI 48206-2081 | 2019-12-11 |
| 1578026076 | Julia Christine Zaddock | Nurse Practitioner | 12800 Toronto St., Detroit, MI 48217 | 2019-04-11 |
| 1629552112 | Katelyn E. Hamann | Nurse Practitioner | Children's Hosptial of Mi, 3901 Beaubien - 2nd Fl - Carl's Bldg, Detroit, MI 48201-2119 | 2018-09-20 |
| 1750801023 | Amy Marie Bertha | Nurse Practitioner | New Center One/endocrinology/metabolism, 3031 W. Grand Blvd, Detroit, MI 48202 | 2017-06-27 |
| 1376077107 | Maryam Hakemi | Nurse Practitioner | 3990 John R. St., Harper University Hospital, Detroit, MI 48201 | 2017-04-19 |
| 1841748076 | Jennifer N. Watson | Nurse Practitioner | 3950 Beaubien - Ground Fl, Children's Hospital of Mi, Detroit, MI 48201-2153 | 2016-09-16 |
| 1891164323 | Cheryl Barratt | Nurse Practitioner | Children's Hospital of Mi - Er, 3901 Beaubien, Detroit, MI 48201 | 2015-09-15 |
| 1730556291 | Markita Marie Thompson | Nurse Practitioner | 277 Gratiot Ave Ste 100a8919, Detroit, MI 48226-2239 | 2015-08-31 |
| 1316372980 | Sarah Kironde | Nurse Practitioner | 7700 2nd Avenue, Detroit, MI 48202 | 2013-09-13 |
| 1679917322 | Arlanda Latrice Smith | Nurse Practitioner | 8904 Woodward Ave, Detroit, MI 48202-1821 | 2013-04-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.