NPIMap

Organization Active NPI

Bronson South Haven Hospital

Doing business as Bronson Medical Group

  • Family Medicine Physician
  • South Haven, MI
National Provider Identifier
1174749170
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1060000042 Issued in MI
Legal business name
BRONSON SOUTH HAVEN HOSPITAL
Doing business as
Bronson Medical Group
Practice address
950 S Bailey Ave
South Haven, MI 49090-8744
Phone
(269) 637-5271
Fax
(269) 639-2818
NPI assigned
Apr 18, 2007
Last updated
Nov 27, 2023By the provider in NPPES
Organization subpart
No

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
Ms. Rebecca L East
Title
SVP, Cfo
Phone
(269) 341-6000

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X NU
General Acute Care Hospital 282N00000X 800020 MI
Family Medicine Physician 207Q00000X 1060000042 MI Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

950 S Bailey Ave
South Haven, MI 49090-8744

Mailing address

601 John St
Box 42
Kalamazoo, MI 49007-5341
Phone (269) 341-8419

Other identifiers 2

IdentifierTypeStateIssuer
800020OtherMILICENSE NUMBER
700H06003OtherMIBCBS GROUP NUMBER

Other names 1

  • Bronson Medical Group 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
O20040305001005 MI Part B Supplier - Clinic/Group Practice 6204724834 Receives reassigned benefits from 211 practitioners
1 other NPI on this enrollment
Practice locations: South Haven, MI

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 294

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.

View all 294

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1174749170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "BOX 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-8419",
            "fax_number": "269-341-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 S BAILEY AVE",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490908744",
            "telephone_number": "269-637-5271",
            "fax_number": "269-639-2818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON SOUTH HAVEN HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-17",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SVP, CFO",
        "authorized_official_telephone_number": "269-341-6000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "MI",
            "license": "800020",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "1060000042",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "800020",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "700H06003",
            "state": "MI"
        }
    ],
    "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 Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bronson Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.