Active NPI
Newaygo Medical Care Facility
- Skilled Nursing Facility
- Fremont, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 628510
- Legal business name
- NEWAYGO MEDICAL CARE FACILITY
- Practice address
- 4465 W 48TH St
Fremont, MI 49412-8721 - Phone
- (231) 924-2020
- Fax
- (231) 924-2366
- NPI assigned
- May 10, 2006
- Last updated
- Nov 16, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Judith Ann Still, LNHA, BSN, RN
- Title
- Administrator
- Phone
- (231) 924-2020
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 628510 | MI | Primary |
Addresses
Primary practice location
4465 W 48TH St
Fremont, MI 49412-8721
Mailing address
4465 W 48TH Street
Fremont, MI 49412
Phone (231) 924-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 612085259 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20111202000388 | MI | Part A Provider - Skilled Nursing Facility | 9335314368 | Practice locations: Fremont, MI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1033168406. Details of each certification follow.
Skilled nursing facility certification: CCN 235076
- Legal name
- NEWAYGO MEDICAL CARE FACILITY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 1, 1967
- Last certification
- May 1, 2025
- Beds
- 116
- Ownership / control type
- Other Nonprofit
- Organization structure
- Government
- Enrollment address
- 4465 W 48TH St
Fremont, MI 49412-8721 - Nursing home name
- NEWAYGO CO MEDICAL CARE FACILITY
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Newaygo Co Medical Care Facility
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Jan 1, 1967
- Medicare certification status
- Active
- Certified beds
- 116
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0708051 | Newaygo Medical Care Facility | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 6
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Kimberly Updike | Operational/Managerial Control | Aug 1, 2021 | |
| Patricia Gray | Corporate Director | Jul 9, 2024 | 100% |
| Operational/Managerial Control | Apr 25, 2025 | ||
| Adp of the SNF | Apr 25, 2025 | ||
| Michael Mercer | Corporate Director | Jan 1, 2015 | |
| County of Newaygo | 5% Or Greater Direct Ownership Interest | Jan 1, 1966 | 100% |
| Krystyna Barbara Solarewicz | Operational/Managerial Control | May 1, 2022 | |
| Adp of the SNF | Jun 27, 2025 | ||
| Philip Alt | Operational/Managerial Control | Oct 2, 2025 | |
| Adp of the SNF | Oct 2, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Chicago, IL
- NPI 1134149727
Adp of the SNF, Operational/Managerial Control
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.
-
- Internal Medicine Physician
- Chicago, IL
- NPI 1134149727
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147219200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1447632000000",
"number": "1033168406",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4465 W 48TH STREET",
"city": "FREMONT",
"state": "MI",
"postal_code": "49412",
"telephone_number": "231-924-2020",
"fax_number": "231-924-2366"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4465 W 48TH ST",
"city": "FREMONT",
"state": "MI",
"postal_code": "494128721",
"telephone_number": "231-924-2020",
"fax_number": "231-924-2366"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "NEWAYGO MEDICAL CARE FACILITY",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-10",
"last_updated": "2015-11-16",
"status": "A",
"authorized_official_last_name": "STILL",
"authorized_official_first_name": "JUDITH",
"authorized_official_middle_name": "ANN",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "231-924-2020",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "LNHA, BSN, RN"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MI",
"license": "628510",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "612085259",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Fremont, MI
- Newaygo County General Hospital Association
- Newaygo County General Hospital Association (Gerber Memorial CRNA)
- Newaygo County General Hospital Association (Corewell Health Gerber Hospital Pediatrics & Walk-In Clinic - Fremont)
- Newaygo County General Hospital Association (Corewell Health Gerber Hospital Professional)
- Newaygo County Resa
- Mai Phuong Nguyen Dang, DO
- Alan L Nieboer, GNP
- Christopher Callis Niquette, DDS
- Julie A Norris, M.D.
- David Wayne Oosting, O.D.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.