Pennock Hospital

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

Legal business name

PENNOCK HOSPITAL

Practice address

1005 W Green St
Hastings, MI 49058-1712

Phone

(269) 948-8411

Fax

(269) 948-9874

NPI assigned

Jun 7, 2011

Last updated

Apr 22, 2016By the provider in NPPES

Organization subpart

Yes

Parent organization

PENNOCK HOSPITALAs reported in NPPES

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

Authorized official

Name

Deidre Weller

Title

Controller

Phone

(269) 945-1212

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pennock Hospital

  • Obstetrics & Gynecology Physician
  • Hastings, MI
  • NPI 1023340981

  O20040301000595

  Same enrollment
• Pennock Hospital

  dba Corewell Health Pennock Hospital Professional

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1518186295

  O20040301000595

  Same enrollment
• Pennock Hospital

  • Orthopaedic Surgery Physician
  • Hastings, MI
  • NPI 1629494133

  O20040301000595

  Same enrollment
• Pennock Hospital

  dba Specialist Group

  • Internal Medicine Physician
  • Hastings, MI
  • NPI 1750500435

  O20040301000595

  Same enrollment
• Pennock Hospital Board of Trustees

  dba Specialist Group

  • Emergency Medicine Physician
  • Hastings, MI
  • NPI 1841488178

  O20040301000595

  Same enrollment

Part of

Pennock Hospital Borad

Practitioners 2

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.

• Tami Lynn Pettenger, DNP

  • Nurse Practitioner
  • Hastings, MI
  • NPI 1235676651
  NPD
• Max D Rappaport, M.D.

  • Surgery Physician
  • Hastings, MI
  • NPI 1366436255
  NPD

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

{
    "created_epoch": "1307404800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461283200000",
    "number": "1215221353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-8411",
            "fax_number": "269-948-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENNOCK HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENNOCK HOSPITAL",
        "enumeration_date": "2011-06-07",
        "last_updated": "2016-04-22",
        "status": "A",
        "authorized_official_last_name": "WELLER",
        "authorized_official_first_name": "DEIDRE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "269-945-1212"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Meghan Pearson, MA TLLP, RAC
• Pediatric Psychological Services
• Whitney Pennington
• Pennock Hospital (Spectrum Health Pennock)
• Pennock Hospital
• Pennock Hospital (Corewell Health Pennock Hospital)
• Pennock Hospital (Corewell Health Pennock Hospital Family Medicine - State St)
• Pennock Hospital (Pennock Hospice)
• Pennock Hospital (Corewell Health Pennock Hospital Professional)
• Pennock Hospital (Pennock Homecare Services)

• Surgery Physician in Hastings, MI
• Providers in Hastings, MI by specialty
• Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2016; 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.