NPIMap

Organization Active NPI

Memorial Medical Center of West Michigan

Doing business as Corewell Health Ludington Hospital Primary Care - Lawndale

  • Rural Health Clinic/Center
  • Ludington, MI
National Provider Identifier
1346628518
Registry record updated Aug 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Doing business as
Corewell Health Ludington Hospital Primary Care - Lawndale
Spectrum Health Ludington Hospital Family and Internal Medicine - Ludi
Practice address
922 Lawndale St
Ludington, MI 49431-1928
Phone
(231) 845-7380
NPI assigned
May 8, 2015
Last updated
Aug 23, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MEMORIAL MEDICAL CENTER OF WEST MICHIGANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 23, 2023

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

Authorized official

Name
John Sella
Title
VP Finance
Phone
(616) 802-0206

Specialties & licenses 1

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

Addresses

Primary practice location

922 Lawndale St
Ludington, MI 49431-1928

Mailing address

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

Other names 2

  • Corewell Health Ludington Hospital Primary Care - Lawndale Doing business as
  • Spectrum Health Ludington Hospital Family and Internal Medicine - Ludi Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150619002207 MI Part A Provider - Rural Health Clinic 3678543659 Practice locations: Ludington, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1346628518. Details of each certification follow.

Rural health clinic certification: CCN 238683

Legal name
MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Doing business as
COREWELL HEALTH LUDINGTON HOSPITAL PRIMARY CARE-LAWNDALE
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
922 Lawndale St
Ludington, MI 49431-1928
Related CCNs
230110

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).

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
23D0696186Corewell Health Ludington Hospital Primary922 Lawndale St, Ludington, MI 49431Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Health20 organizations share this tax ID, including this one
Part of
Spectrum Health

Other organizations with this tax ID 19

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

View all 19

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 & Ceo Sep 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 EmployeeNA 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 May 1, 2015
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 EmployeeNA 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.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Corewell Health Ludington Hospital Family Medicine-HartHart, MI, CCN 238676 Rural health clinic 5% Or Greater Direct Ownership Interest (100%) Jul 1, 2014

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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": "1431043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1346628518",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "922 LAWNDALE ST",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494311928",
            "telephone_number": "231-845-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL MEDICAL CENTER OF WEST MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEMORIAL MEDICAL CENTER OF WEST MICHIGAN",
        "enumeration_date": "2015-05-08",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A",
        "authorized_official_last_name": "SELLA",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-802-0206"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Ludington Hospital Primary Care - Lawndale",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Ludington Hospital Family and Internal Medicine - Ludi",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Ludington Hospital Family and Internal Medicine - Ludi",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ludington, MI

Sources for this page

Verify at the official NPI Registry.