NPIMap

Organization Active NPI

Lakeland Community Hospital Watervliet

Doing business as Corewell Health Watervliet Hospital

  • Rural Health Clinic/Center
  • Dowagiac, MI
National Provider Identifier
1184467607
Registry record updated Jun 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
LAKELAND COMMUNITY HOSPITAL WATERVLIET
Doing business as
Corewell Health Watervliet Hospital
Practice address
520 Main St
Dowagiac, MI 49047-1762
Phone
(269) 390-0536
NPI assigned
Jun 13, 2024
Last updated
Jun 13, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2024

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

Authorized official

Name
Matthew E Cox
Title
Cfo
Phone
(616) 437-2146

Specialties & licenses 1

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

Addresses

Primary practice location

520 Main St
Dowagiac, MI 49047-1762

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 1

  • Corewell Health Watervliet Hospital Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240803000139 MI Part A Provider - Rural Health Clinic 7416942750 Practice locations: Dowagiac, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184467607. Details of each certification follow.

Rural health clinic certification: CCN 238779

Legal name
LAKELAND COMMUNITY HOSPITAL WATERVLIET
Doing business as
COREWELL HEALTH WATERVLIET HOSPITAL PRIMARY CARE-DOWAGIAC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 10, 2025
Last certification
Jul 10, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
520 Main St
Dowagiac, MI 49047-1762
Related CCNs
230078

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).

National Provider Directory

National Provider Directory
Tax ID family
Hartford Med CNTR12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

56190 M 43
Bangor, MI 49013
Phone (616) 427-5304

6633 Red Arrow Hwy
Coloma, MI 49038
Phone (269) 468-7142

520 Main St
Dowagiac, MI 49047
Phone (269) 390-0536

525 S Center St
Hartford, MI 49057
Phone (269) 621-4063

420 Medical Park Dr
Watervliet, MI 48098

420 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-2431

420 Medical Park Dr
Community Hospital After Hours Clinic
Watervliet, MI 49098

450 Medical Park Dr
#200
Watervliet, MI 49098
Phone (269) 463-4000

450 Medical Park Dr
Ste 300
Watervliet, MI 49098
Phone (269) 463-6900

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Kenneth Oneill Individual Corporate Director Jan 1, 2022
Jerry French Individual Corporate Director Jan 1, 2024
Christina Freese Decker Individual Other Oct 1, 2019
Pamela Garmon Johnson Individual Corporate Director Jan 1, 2022
Deborah L Bennett Berecz Individual Corporate Director Jan 1, 2023
Scott Smith Individual Corporate Director Jan 1, 2008
Amey Upton Individual Corporate Director Mar 24, 2024
Teresa Arlene Treiber Individual W-2 Managing Employee Nov 1, 2025
Lakeland Regional Health System Organization, Saint Joseph, MI Corporation Operational/Managerial Control Oct 1, 2018
Dana Wales Individual Corporate Director Jan 1, 2023
Matthew E Cox Individual Corporate OfficerSVP Chief Finance Officer Feb 1, 2022
Corporate DirectorSVP Chief Finance Officer Feb 1, 2022
Operational/Managerial Control Feb 1, 2022
Corewell Health Organization, Grand Rapids, MI Corporation, Non-profit, Chain home office Operational/Managerial Control Oct 1, 2018
Bertha King Individual Corporate Director Aug 29, 2023
Stephen L Hempel Individual Corporate Director Jan 1, 2024
Christine Vanlandingham Individual Corporate Director Jan 1, 2010
Carey Martin Individual Corporate Director Jan 1, 2022
Tamila Marlow Individual W-2 Managing Employee Nov 1, 2025
David Schaffer Individual Corporate Director Jan 1, 2022

Facilities with the same owner 66

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

View all 66

Practitioners & affiliated clinicians

Practitioners 166

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 166

NPI Registry JSON

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

{
    "created_epoch": "1718236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718236800000",
    "number": "1184467607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 MAIN ST",
            "city": "DOWAGIAC",
            "state": "MI",
            "postal_code": "490471762",
            "telephone_number": "269-390-0536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND COMMUNITY HOSPITAL WATERVLIET",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-06-13",
        "last_updated": "2024-06-13",
        "certification_date": "2024-06-13",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-437-2146"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Watervliet Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dowagiac, MI

Sources for this page

Verify at the official NPI Registry.