NPIMap

Organization Active NPI

Newaygo County General Hospital Association

Doing business as Spectrum Health Gerber Memorial Family Medicine - Grant

  • Rural Health Clinic/Center
  • Grant, MI
National Provider Identifier
1013040492
Registry record updated Jun 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Doing business as
Spectrum Health Gerber Memorial Family Medicine - Grant
Practice address
230 S Maple St
Grant, MI 49327-9006
Phone
(231) 834-5995
Fax
(231) 834-0248
NPI assigned
Mar 14, 2007
Last updated
Jun 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2016

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

Authorized official

Name
Randall J Stasik
Title
President
Phone
(231) 924-1340

Specialties & licenses 1

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

Addresses

Primary practice location

230 S Maple St
Grant, MI 49327-9006

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other identifiers 1

IdentifierTypeStateIssuer
4383367MedicaidMI

Other names 1

  • Spectrum Health Gerber Memorial Family Medicine - Grant Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040423001232 MI Part B Supplier - Clinic/Group Practice 4880503051 Receives reassigned benefits from 205 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fremont, MI; Newaygo, MI; Hesperia, MI

Other NPIs on the same Medicare enrollment 6

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

National Provider Directory

National Provider Directory

Ownership & related parties

Change-of-ownership history 1

DateEventCounterparty
Jun 28, 2019 Change of OwnershipThis provider was the seller Corewell Health Ludington Hospital Family Medicine-GrantCCN 238572, MI, NPI 1932662996

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464912000000",
    "number": "1013040492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S MAPLE ST",
            "city": "GRANT",
            "state": "MI",
            "postal_code": "493279006",
            "telephone_number": "231-834-5995",
            "fax_number": "231-834-0248"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2016-06-03",
        "status": "A",
        "authorized_official_last_name": "STASIK",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-924-1340"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4383367",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Health Gerber Memorial Family Medicine - Grant",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grant, MI

Sources for this page

Verify at the official NPI Registry.