NPIMap

Organization Active NPI

Catherines Health Center

  • Federally Qualified Health Center (FQHC)
  • Wyoming, MI
National Provider Identifier
1134872005
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATHERINES HEALTH CENTER
Practice address
950 36TH St SW
Wyoming, MI 49509-3587
Phone
(616) 336-8800
NPI assigned
Feb 1, 2022
Last updated
Feb 1, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
CATHERINES HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Authorized official

Name
Sara Brooks, MPA
Title
Director of Operations
Phone
(616) 336-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

950 36TH St SW
Wyoming, MI 49509-3587

Mailing address

1211 Lafayette Ave NE
Grand Rapids, MI 49505-5092

Other names 2

  • Catherine's Health Center Wyoming Other name
  • Catherines Health Center Wyoming Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140520000626 MI Part B Supplier - Clinic/Group Practice 2860615838 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wyoming, MI; Grand Rapids, MI
O20220613000528 MI Part A Provider - Federally Qualified Health Center (FQHC) 2860615838 Practice locations: Wyoming, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1134872005. Details of each certification follow.

Federally qualified health center certification: CCN 231182

Legal name
CATHERINE'S HEALTH CENTER
Doing business as
CATHERINE'S HEALTH CENTER WYOMING
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 9, 2022
Last certification
Jun 9, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
950 36TH St SW
Wyoming, MI 49509-3587

Other NPIs with the same Medicare PAC ID 13

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

View all 13

Other NPIs on the same Medicare enrollment 5

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
23D2261888Catherine's Health Center Wyoming950 36TH Street S W, Wyoming, MI 49509Provider-performed microscopyJun 6, 2028

National Provider Directory

National Provider Directory
Tax ID family
Catherine's Health Center13 organizations share this tax ID, including this one
Part of
Catherine's Health Center

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kenneth S Johnson Individual Corporate Director Jan 1, 2023
Yvonne George Individual Corporate Director Jan 1, 2023
Sara Brooks Individual Corporate DirectorDirector of Operations Feb 1, 2022 8%
W-2 Managing EmployeeDirector of Operations Oct 4, 2021
Dustin Maynes Individual Corporate DirectorDirector of Finance Feb 1, 2022 8%
Adrienne Goodstal Individual Corporate OfficerVice President Jan 1, 2023
Allison Shook Individual Corporate DirectorDevelopment Director Feb 1, 2022 8%
Cole Sweda Individual Corporate Director Jan 1, 2024
Jade Kennedy Individual Corporate Officer Jan 1, 2026
Catherine Kelly Individual Corporate Director Jan 1, 2023
Zandra Vazquez Individual Corporate Officer Jan 1, 2026
Megan Erskine Individual Corporate OfficerCeo Apr 12, 2022
W-2 Managing EmployeeAd; Apr 12, 2022
Operational/Managerial Control Apr 12, 2022 100%
Mark a Contreras Individual Corporate DirectorMedical Director Feb 1, 2022 8%
William Williams Individual Corporate Director Jan 1, 2023
Andrea Cosier Individual Corporate Director Jan 1, 2023 8%
Alisha Davis Individual Corporate Director Jan 1, 2023 8%
Rick Schuitema Individual Corporate OfficerTreasurer Jan 1, 2024

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Catherine's Health Dental CenterGrand Rapids, MI, CCN 231163 Federally qualified health center Operational/Managerial Control (100%) Aug 11, 2005
Catherine's Health Center - Mel TrotterGrand Rapids, MI, CCN C71009 Federally qualified health center Operational/Managerial Control (100%) Nov 8, 2023
Catherine's Health Center - CrossroadsGrand Rapids, MI, CCN C71013 Federally qualified health center Operational/Managerial Control (100%) Dec 29, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Practitioners & affiliated clinicians

Practitioners 2

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": "1643673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643673600000",
    "number": "1134872005",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 36TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495093587",
            "telephone_number": "616-336-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHERINES HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATHERINES HEALTH CENTER",
        "enumeration_date": "2022-02-01",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "616-336-8800",
        "authorized_official_credential": "MPA"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catherine's Health Center Wyoming",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Catherines Health Center Wyoming",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Wyoming, MI

Sources for this page

Verify at the official NPI Registry.