NPIMap

Organization Active NPI

Community Health Center of Branch County

Doing business as CHC Pediatric and Adolescent Center

  • Rural Health Clinic/Center
  • Coldwater, MI
National Provider Identifier
1073661484
Registry record updated Sep 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Doing business as
CHC Pediatric and Adolescent Center
Practice address
358 E Chicago St
Coldwater, MI 49036-2072
Phone
(517) 279-5252
Fax
(517) 279-5253
NPI assigned
Jan 8, 2007
Last updated
Sep 7, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 7, 2012

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

Authorized official

Name
Randall (Randy) Degroot
Title
Ceo
Phone
(517) 279-5489

Specialties & licenses 1

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

Addresses

Primary practice location

358 E Chicago St
Coldwater, MI 49036-2072

Mailing address

274 E Chicago St
Coldwater, MI 49036-2041
Phone (517) 279-5400

Other identifiers 1

IdentifierTypeStateIssuer
238615OtherMEDICARE RHC PROVIDER NUMBER

Other names 1

  • CHC Pediatric and Adolescent Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080214000414 MI Part A Provider - Rural Health Clinic 9335037514 1 other NPI on this enrollment
Practice locations: Coldwater, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073661484. Details of each certification follow.

Rural health clinic certification: CCN 238615

Legal name
COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Doing business as
CHC PEDIATRICS AND ADOLESCENT CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 25, 2009
Last certification
May 23, 2023
Ownership / control type
1B
Organization structure
CorporationNon-profit
Incorporated
Mar 22, 1938 in MI
Enrollment address
358 E Chicago St
Ste C
Coldwater, MI 49036-2072
Related CCNs
230022

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0377619CHC Pediatrics358 E Chicago Street, Suite 202, Coldwater, MI 49036Certificate of waiverMar 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Community HLTH CNTR19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

450 E Grant St
Bronson, MI 49028
Phone (517) 279-5296

358 E Chicago St
Ste C
Coldwater, MI 49036
Phone (517) 279-5252

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Neal Dantes Individual Corporate DirectorBoard Member Jan 1, 2011 11%
Branch County Treasurer Organization, Coldwater, MI 5% Or Greater Direct Ownership Interest Jun 1, 1996 100%
John Morrell Individual Corporate Officer Jan 1, 2013
David Fuchs Individual Corporate Officer Sep 23, 2014
Linden Cox Individual Corporate DirectorBoard Member Jan 1, 2006 11%
Mary Rose Individual Corporate DirectorCco Feb 1, 2016
Randall C Degroot Individual Contracted Managing Employee Feb 1, 2016
Connie Petch Individual Contracted Managing EmployeeCfo Jun 29, 2016
Corporate DirectorCfo Jun 29, 2016
Dennis Knapp Individual Corporate Officer Nov 12, 2013
Tanya Wines Individual Corporate DirectorDirector Jan 1, 2021
Jaylen T Johnson Individual Corporate Officer Jan 1, 2016
Michael L Iveson Individual Corporate DirectorBoard Member Nov 1, 1999 11%
Promedica Health System Inc Organization, Toledo, OH Corporation Operational/Managerial Control Feb 1, 2016

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 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1168214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346976000000",
    "number": "1073661484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 E CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362041",
            "telephone_number": "517-279-5400",
            "fax_number": "517-279-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 E CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362072",
            "telephone_number": "517-279-5252",
            "fax_number": "517-279-5253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF BRANCH COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-08",
        "last_updated": "2012-09-07",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "RANDALL (RANDY)",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "517-279-5489"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RHC PROVIDER NUMBER",
            "identifier": "238615",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHC Pediatric and Adolescent Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Coldwater, MI

Sources for this page

Verify at the official NPI Registry.