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Bronson Lakeview Hospital

Organization Active NPI Rural Health Clinic/Center · Bangor, MI

NPI 1104459627 · NPPES record last updated Nov 27, 2023

Key facts

NPI
1104459627
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Practice address
520 Railroad St
Bangor, MI 49013-1490
Phone
(269) 427-5811
Fax
(269) 427-6107
NPI assigned
Feb 13, 2020
Organization subpart
Yes
Parent organization (as reported)
BRONSON LAKEVIEW HOSPITAL

Authorized official

Name
Rebecca East
Title
Cfo
Phone
(269) 341-6000

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Owners & managing parties with NPI records 5

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 2

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

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

Facilities with the same owner 11

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

Practitioners 72

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

View all 72

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0895434Bronson Lakeview Family Care Bangor
520 Railroad Street, Bangor, MI 49013		Provider-performed microscopyJan 11, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Rural health clinic certification: CCN 238533

Legal name
BRONSON LAKEVIEW HOSPITAL
Doing business as
BRONSON LAKEVIEW FAMILY CARE - BANGOR
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Aug 29, 1996
Last certification
Apr 10, 2025
Ownership / control type
2B
Most recent change of ownership
Mar 31, 2020 (1 total)
Organization structure
Corporation · Non-profit
Enrollment address
520 Railroad St
Bangor, MI 49013-1490
Related CCNs
231332

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Bill Harold Manns
Individual 		Corporate Officer
President & Ceo		 Jan 1, 2020
William B Workman
Individual 		Corporate Director
Vice Chief of Staff		 Jul 1, 2022
Rebecca East
Individual 		Corporate Officer
Cfo		 Jan 1, 2015
Michael F Odar
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Steven J Lins
Individual 		Corporate Director
Chief of Staff		 Jan 1, 2011
Erick Stewart
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Katharine Hermsen
Individual 		Corporate Director Jan 1, 2025
Robert M Nicholson
Individual 		Corporate Director Jul 1, 2024
James L Liggins
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Leigh Ann Colegrove
Individual 		W-2 Managing Employee
System Credentialing Coordinator		 Oct 11, 2021
Lynn Chen-Zhang
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Jorge Gonzalez
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Namita Sharma
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Richard J Allen
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Kellie Hoffman
Individual 		Corporate Director Jan 1, 2025
Genevieve Coleman
Individual 		Corporate Director Jan 1, 2025
Bronson Health Care Group Inc
Organization · Kalamazoo, MI
Corporation, Non-profit, Chain home office 		5% Or Greater Direct Ownership Interest Apr 3, 2020 100%
Operational/Managerial Control Apr 2, 2020 100%
Rachel Worgess
Individual 		Corporate Director Jan 1, 2025
Scott C Gibson
Individual 		Corporate Director
Board Member		 Jan 1, 2006
Luther Marshall Washington
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Randall W. Eberts
Individual 		Corporate Director
Vice Chair		 Jan 1, 1999
Grace Lubwama
Individual 		Corporate Director Jan 1, 2025
Brenda L Hunt
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Donald R. Parfet
Individual 		Corporate Director
Board Member		 Jan 1, 1986
James B Falahee
Individual 		Corporate Officer
Chief Legal Officer		 Jan 1, 1995
Neil Nyberg
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Nelson Karre
Individual 		Corporate Director
Chair		 Jan 1, 2011

Change-of-ownership history

DateEventCounterparty
Mar 31, 2020 Change of Ownership
This provider was the buyer		 Bronson South Haven Family Medicine Cooper Clinic
CCN 238533 · MI · NPI 1770599052

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20200413001955 MI Part a Provider - Rural Health Clinic 9032008495 Practice locations: Bangor, MI

National Provider Directory

Tax ID family
Lake View Community Hos (3 organizations share this tax ID)
Part of
Lake View Community Hos

Locations

451 Health Pkwy
Ste F
Paw Paw, MI 49079
Phone (269) 655-3080

Specialties & licenses

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

Addresses

Primary practice location

520 Railroad St
Bangor, MI 49013-1490

Mailing address

301 John St # 42
Kalamazoo, MI 49007-5295
Phone (269) 341-8536

Other names

  • Bronson LakeView Family Care Bangor Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Other providers in Bangor, MI

All providers in Bangor, MI · Rural Health Clinic/Center in Michigan

Sources for this page

Verify at the official NPI Registry.