NPIMap

Organization Active NPI

Mecosta County Medical Center

Doing business as Corewell Health Big Rapids Hospital Family Medicine - 215th Ave

  • Rural Health Clinic/Center
  • Big Rapids, MI
National Provider Identifier
1184912396
Registry record updated Sep 14, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MECOSTA COUNTY MEDICAL CENTER
Doing business as
Corewell Health Big Rapids Hospital Family Medicine - 215th Ave
Corewell Health Big Rapids Hospital Family Medicine - 650 Linden St
Spectrum Health Big Rapids Hospital Family Medicine
Practice address
14755 215TH Ave
Big Rapids, MI 49307-9224
Phone
(231) 796-3200
Fax
(231) 796-5562
NPI assigned
Jul 21, 2011
Last updated
Sep 14, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MECOSTA COUNTY MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 14, 2023

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

Authorized official

Name
Amanda Knuth
Title
Ceo
Phone
(231) 349-1616

Specialties & licenses 1

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

Addresses

Primary practice location

14755 215TH Ave
Big Rapids, MI 49307-9224

Mailing address

100 Michigan St NE
Mc845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

Other names 3

  • Corewell Health Big Rapids Hospital Family Medicine - 215th Ave Doing business as
  • Corewell Health Big Rapids Hospital Family Medicine - 650 Linden St Doing business as
  • Spectrum Health Big Rapids Hospital Family Medicine Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20111110000688 MI Part A Provider - Rural Health Clinic 1951215540 Practice locations: Big Rapids, MI
O20130328000248 MI Part A Provider - Rural Health Clinic 1951215540 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Stanwood, MI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1184912396. Details of each certification follow.

Rural health clinic certification: CCN 238652

Legal name
MECOSTA COUNTY MEDICAL CENTER
Doing business as
COREWELL HEALTH BIG RAPIDS HOSPITAL FAMILY MEDICINE-215TH AVE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 1, 2011
Last certification
Sep 12, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 1966 in MI
Enrollment address
14755 215TH Ave
Big Rapids, MI 49307-9224
Related CCNs
230093

Rural health clinic certification: CCN 238667

Legal name
MECOSTA COUNTY MEDICAL CENTER
Doing business as
COREWELL HEALTH BIG RAPIDS HOSPITAL FAMILY MEDICINE-CANADIAN LAKES
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 27, 2014
Last certification
Aug 5, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
8354 100TH Ave
Ste 1
Stanwood, MI 49346-8345
Related CCNs
230093

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).

Other NPIs on the same Medicare enrollment 1

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
23D0878010Corewell Health Big Rapids Family14755 215TH Ave, Big Rapids, MI 49307Provider-performed microscopyOct 14, 2027

National Provider Directory

National Provider Directory
Part of
Mecosta County General

Locations

650 Linden St
Ste 1
Big Rapids, MI 49307
Phone (231) 796-3200

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Christina Freese Decker Individual Other Oct 1, 2018
Corporate Director Aug 18, 2020
OtherPresident and Ceo Oct 1, 2018
Talawnda L Bragg Individual Corporate Director Jan 1, 2022
Christopher B Port Individual Corporate Director Aug 18, 2020
Ronald M Hofman Individual Corporate Director Aug 18, 2020
Annica Euurand Waalkes Individual Corporate Director Aug 18, 2020
Teresa Arlene Treiber Individual W-2 Managing Employee Nov 1, 2025
Matthew E Cox Individual Corporate OfficerSVP Chief Finance Officer Feb 1, 2022
Operational/Managerial Control Feb 1, 2022
Mark Wilson Individual Corporate Director Aug 18, 2020
Corewell Health Organization, Grand Rapids, MI Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 1, 2013
Johannie M Torres Individual Corporate Director Aug 18, 2020
Mary Doornbos Individual Corporate Director Aug 18, 2020
John Buckley Individual Corporate Director Aug 18, 2020
Sam R Watson Individual Corporate Director Aug 18, 2020
Bill P Pink Individual Corporate Director Aug 18, 2020
Simin Beg Individual Corporate Director Aug 18, 2020
Lynnette Ferrell-Robinson Individual Corporate Director Aug 18, 2020
Tamila Marlow Individual W-2 Managing Employee Nov 1, 2025

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 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1311206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1694649600000",
    "number": "1184912396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790",
            "fax_number": "616-486-6702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14755 215TH AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079224",
            "telephone_number": "231-796-3200",
            "fax_number": "231-796-5562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECOSTA COUNTY MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MECOSTA COUNTY MEDICAL CENTER",
        "enumeration_date": "2011-07-21",
        "last_updated": "2023-09-14",
        "certification_date": "2023-09-14",
        "status": "A",
        "authorized_official_last_name": "KNUTH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "231-349-1616"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Big Rapids Hospital Family Medicine - 215th Ave",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Corewell Health Big Rapids Hospital Family Medicine - 650 Linden St",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Big Rapids Hospital Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Big Rapids, MI

Sources for this page

Verify at the official NPI Registry.