Ascension Borgess Lee Hospital
Organization Active NPI Rural Health Clinic/Center · Dowagiac, MI
NPI 1194717504 · NPPES record last updated May 23, 2024
Key facts
- NPI
- 1194717504
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- ASCENSION BORGESS LEE HOSPITAL
- Practice address
- 420 W. High Street
Dowagiac, MI 49047-1762 - Phone
- (269) 783-3052
- NPI assigned
- Aug 22, 2005
- Organization subpart
- No
Authorized official
- Name
- Marina Houghton
- Title
- Cfo
- Phone
- (269) 226-4800
Owners & managing parties with NPI records 2
-
James Bailey Babel, M.D.
-
Paul Anton Hodge, O.D.
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Related certifications (CCN) 1
Facilities with the same owner 21
Practitioners 67
-
William Francis Lapenna, M.D.
-
Min Luo, D.O.
-
Joseph Prano, D.O.
-
Frank S Saltiel, M.D.
-
Ashish Verma, M.D.
-
Rebecca Jo Burnau, FNP-C, PMHNP-BC
-
William Stanton Davis, PMHNP-BC
-
Robert E Dempsey, D.O.
-
Geetha Dhatreecharan, M.D.
-
Nancy Jo Fantetti, FNP
-
Suzanne Jeanne Huberty, M.D.
-
Kenneth A Jordan, MD
-
Jagadeesh Kumar Kalavakunta, M.D.,
-
Alicia Jean Lane, MSN, RN, FNP-C
-
Zhigang Liu, M.D., PH.D.
-
Niaz Mohammad, MD
-
Jonathan Nykamp, FNP
-
Erin Hall Rafferty, FNP-C
-
Theresa I Rinehart, FNP-C
-
Erica Rogers, NP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Rural health clinic certification: CCN 238544
- Legal name
- ASCENSION BORGESS LEE HOSPITAL
- Doing business as
- BEACON DOWAGIAC
- Certification status
- Active
- Provider type (POS)
- Rural health clinic
- Participating since
- Mar 26, 1997
- Last certification
- Jun 17, 2024
- Ownership / control type
- 2B
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 420 W High St
Dowagiac, MI 49047-1943 - Related CCNs
- 231315
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Paul Hodge |
Corporate Officer |
Jul 1, 2025 | |
| Irene Maffetone |
W-2 Managing Employee |
Jul 1, 2025 | |
| James H Connell |
Corporate Officer |
Jul 1, 2025 | |
| Beacon Health System Inc |
Operational/Managerial Control | Jul 1, 2025 | |
| Jeffrey P Costello |
Corporate Officer |
Jul 1, 2025 | |
| W-2 Managing Employee |
Jul 1, 2025 | ||
| Operational/Managerial Control |
Jul 1, 2025 | 100% | |
| Mary Gondeck |
Corporate Officer |
Jul 1, 2025 | |
| Jason E Burchardt |
Corporate Officer |
Jul 1, 2025 | |
| Thelma Susan Pozo |
Corporate Officer |
Jul 1, 2025 | |
| Charles Burling |
Corporate Officer |
Jul 1, 2025 | |
| James Bailey Babel |
Corporate Officer |
Jul 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031119000763 | MI | Part B Supplier - Clinic/Group Practice | 7719881002 |
Receives reassigned benefits from 45 practitioners 1 other NPI on this enrollment Practice locations: Dowagiac, MI |
| O20080304000655 | MI | Part a Provider - Rural Health Clinic | 7719881002 | Practice locations: Dowagiac, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | MI | Yes |
Addresses
Primary practice location
420 W. High Street
Dowagiac, MI 49047-1762
Mailing address
1717 Shaffer Street
Suite 002
Kalamazoo, MI 49048
Phone (269) 552-2830
Other practice location 1
520 Main St Ste A
Dowagiac, MI 49047-1762
Phone (269) 783-3052
Other names
- Borgess Lee Medical Group
Other providers in Dowagiac, MI
- Alan K Montgomery OD
- Lisa D Andersen
- John Albert Anible II
- Apex Drug Stores Inc
- Ascension Borgess Lee Hospital
- Ascension Borgess Lee Hospital
- Ascension Borgess Lee Hospital
- Ascension Borgess Lee Hospital
- Ascension Borgess Lee Hospital
- Ascension Borgess Lee Hospital
All providers in Dowagiac, MI · Rural Health Clinic/Center in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.