NPIMap

Organization Active NPI

Newaygo County General Hospital Association

Doing business as Corewell Health Gerber Hospital Multispecialty Clinic - Fremont

  • Rural Health Clinic/Center
  • Fremont, MI
National Provider Identifier
1194118265
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Doing business as
Corewell Health Gerber Hospital Multispecialty Clinic - Fremont
Spectrum Health Gerber Memorial Multispecialty Clinic Fremont
Practice address
230 W Oak St
Fremont, MI 49412-1526
Phone
(231) 924-4200
NPI assigned
Mar 12, 2015
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
John Sella
Title
Controller
Phone
(616) 802-0206

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Family Medicine Physician 207Q00000X NU

Addresses

Primary practice location

230 W Oak St
Fremont, MI 49412-1526

Mailing address

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

Other names 2

  • Corewell Health Gerber Hospital Multispecialty Clinic - Fremont Doing business as
  • Spectrum Health Gerber Memorial Multispecialty Clinic Fremont Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150512002458 MI Part A Provider - Rural Health Clinic 4880503051 Practice locations: Fremont, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1194118265. Details of each certification follow.

Rural health clinic certification: CCN 238684

Legal name
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Doing business as
COREWELL HEALTH GERBER HOSPITAL MULTISPECIALTY CLINIC-FREMONT
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 8, 2015
Last certification
Sep 8, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
230 W Oak St
Fremont, MI 49412-1526
Related CCNs
231338

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
23D0379197Corewell Health Gerber Multispecialty230 W Oak Street, Fremont, MI 49412Provider-performed microscopyAug 31, 2026
23D2297150Corewell Health Addiction Clinic - Fremont230 W Oak Street, Fremont, MI 49412Certificate of waiverJan 10, 2028

National Provider Directory

National Provider Directory
Tax ID family
Hesperia Medical Center15 organizations share this tax ID, including this one
Part of
Hesperia Medical Center

Other organizations with this tax ID 14

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

View all 14

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 Corporate Director Aug 18, 2020
OtherPresident and Ceo May 21, 2019
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 Apr 2, 2015
Johannie M Torres Individual Corporate Director Aug 18, 2020
Mary Doornbos Individual Corporate Director Aug 18, 2020
John Buckley Individual Corporate Director Oct 1, 2011
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": "1426118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1194118265",
    "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",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 W OAK ST",
            "city": "FREMONT",
            "state": "MI",
            "postal_code": "494121526",
            "telephone_number": "231-924-4200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION",
        "enumeration_date": "2015-03-12",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "SELLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "616-802-0206"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Gerber Hospital Multispecialty Clinic - Fremont",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Gerber Memorial Multispecialty Clinic Fremont",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fremont, MI

Sources for this page

Verify at the official NPI Registry.