NPIMap

Organization Active NPI

Bronson Lakeview Hospital

Doing business as Bronson LakeView Family Care Bangor

  • Rural Health Clinic/Center
  • Bangor, MI
National Provider Identifier
1104459627
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Doing business as
Bronson LakeView Family Care Bangor
Practice address
520 Railroad St
Bangor, MI 49013-1490
Phone
(269) 427-5811
Fax
(269) 427-6107
NPI assigned
Feb 13, 2020
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
BRONSON LAKEVIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Bronson LakeView Family Care Bangor Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1104459627. Details of each certification follow.

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
CorporationNon-profit
Enrollment address
520 Railroad St
Bangor, MI 49013-1490
Related CCNs
231332

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

Other NPIs with the same Medicare PAC ID 5

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

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
23D0895434Bronson Lakeview Family Care Bangor520 Railroad Street, Bangor, MI 49013Provider-performed microscopyJan 11, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lakeview Comm Hospital3 organizations share this tax ID, including this one
Part of
Lakeview Comm Hospital

Other organizations with this tax ID 2

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

Ownership & related parties

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 OfficerPresident & Ceo Jan 1, 2020
William B Workman Individual Corporate DirectorVice Chief of Staff Jul 1, 2022
Rebecca East Individual Corporate OfficerCfo Jan 1, 2015
Michael F Odar Individual Corporate DirectorBoard Member Jan 1, 2016
Steven J Lins Individual Corporate DirectorChief of Staff Jan 1, 2011
Erick Stewart Individual Corporate DirectorBoard 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 DirectorBoard Member Jan 1, 2016
Leigh Ann Colegrove Individual W-2 Managing EmployeeSystem Credentialing Coordinator Oct 11, 2021
Lynn Chen-Zhang Individual Corporate DirectorBoard Member Nov 1, 2022
Jorge Gonzalez Individual Corporate DirectorBoard Member Jan 1, 2017
Namita Sharma Individual Corporate DirectorBoard Member Nov 1, 2022
Richard J Allen Individual Corporate DirectorBoard 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 DirectorBoard Member Jan 1, 2006
Luther Marshall Washington Individual Corporate DirectorBoard Member Nov 1, 2022
Randall W. Eberts Individual Corporate DirectorVice Chair Jan 1, 1999
Grace Lubwama Individual Corporate Director Jan 1, 2025
Brenda L Hunt Individual Corporate DirectorBoard Member Jan 1, 2011
Donald R. Parfet Individual Corporate DirectorBoard Member Jan 1, 1986
James B Falahee Individual Corporate OfficerChief Legal Officer Jan 1, 1995
Neil Nyberg Individual Corporate DirectorBoard Member Jan 1, 2011
Nelson Karre Individual Corporate DirectorChair Jan 1, 2011

Owners & managing parties with NPI records 5

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

Facilities with the same owner 11

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

Change-of-ownership history 1

DateEventCounterparty
Mar 31, 2020 Change of OwnershipThis provider was the buyer Bronson South Haven Family Medicine Cooper ClinicCCN 238533, MI, NPI 1770599052

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.

NPI Registry JSON

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

{
    "created_epoch": "1581552000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1104459627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 JOHN ST # 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075295",
            "telephone_number": "269-341-8536",
            "fax_number": "269-341-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 RAILROAD ST",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131490",
            "telephone_number": "269-427-5811",
            "fax_number": "269-427-6107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON LAKEVIEW HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONSON LAKEVIEW HOSPITAL",
        "enumeration_date": "2020-02-13",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "269-341-6000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bronson LakeView Family Care Bangor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bronson LakeView Family Care Bangor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bangor, MI

Sources for this page

Verify at the official NPI Registry.