NPIMap

Organization Active NPI

Bronson Lakeview Hospital

  • Rural Health Clinic/Center
  • Paw Paw, MI
National Provider Identifier
1356565170
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Practice address
451 Health Pkwy
Paw Paw, MI 49079-8242
Phone
(269) 657-2550
Fax
(269) 657-2285
NPI assigned
Apr 12, 2007
Organization subpart
Yes
Parent organization
BRONSON LAKEVIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Rebecca East
Title
SVP, Cfo
Phone
(269) 341-6000

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary
Rural Acute Care Hospital 282NR1301X 80-0041 MI

Addresses

Primary practice location

451 Health Pkwy
Paw Paw, MI 49079-8242

Mailing address

301 John St
Box 42
Kalamazoo, MI 49007-5295
Phone (269) 341-7806

Other names 1

  • Bronson Lakeview Family Care-Paw Paw Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080517000073 MI Part A Provider - Rural Health Clinic 9032008495 Practice locations: Paw Paw, MI

Rural health clinic certification: CCN 238601

Legal name
BRONSON LAKEVIEW HOSPITAL
Doing business as
BRONSON LAKEVIEW FAMILY CARE-PAW PAW
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 1, 2007
Last certification
May 9, 2024
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Oct 25, 2007 in MI
Enrollment address
451 Health Pkwy
Ste a
Paw Paw, MI 49079-8242
Related CCNs
231332

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
23D0377816Bronson Lakeview Family Care - Paw Paw451 Health Parkway Ste G, Paw Paw, MI 49079Provider-performed microscopyMar 1, 2028

National Provider Directory

National Provider Directory
Part of
Lake View Community Hos

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Bill Harold Manns Individual Corporate OfficerPresident & Ceo Jan 1, 2020
Mike Way Individual Corporate OfficerSVP Jan 1, 1986
Rebecca East Individual Corporate OfficerSVP, Cfo Feb 1, 2015
W-2 Managing EmployeeSVP, Cfo Feb 1, 2015
Lajune Montgomery-Tabron Individual Corporate DirectorBoard Member Jul 1, 2011
Denise Neely Individual Corporate OfficerSVP, Coo Jan 1, 2005
Michael F Odar Individual Corporate DirectorDirector Jul 1, 2016
Steven J Lins Individual Corporate DirectorBoard Member Jul 1, 2011
Barbara L James Individual Corporate Director Jan 1, 2008
Susan Reinoehl Individual Corporate OfficerSVP, Cso Jan 1, 1995
Ashley Rhoderick Individual W-2 Managing Employee Apr 24, 2020
Mark B Atkinson Individual Corporate DirectorDirector Sep 28, 2012
James L Liggins Individual Corporate DirectorDirector Jan 1, 2016
Cheryl Johnson Individual Corporate OfficerSVP, Cpo Jan 1, 2021
Leigh Ann Colegrove Individual W-2 Managing EmployeeSystem Credentialing Coordinator Oct 11, 2021
William D Johnston Individual Corporate DirectorBoard Member Jul 1, 2011
Jorge Gonzalez Individual Corporate DirectorDirector Jan 1, 2018
Richard J Allen Individual Corporate DirectorDirector Jan 1, 2017
Bronson Health Care Group Inc Organization, Kalamazoo, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Aug 18, 2015 100%
Scott Larson Individual Corporate OfficerSVP Cmo Jun 1, 2014
W-2 Managing EmployeeSVP Cmo Jun 1, 2014
Sridhar Chalasani Individual Corporate OfficerSystem Chief of Staff Jan 1, 2020
Mary Fink Individual Corporate DirectorDirector Jan 1, 2017
Scott C Gibson Individual Corporate Director Jun 1, 2008
Mahesh C Karamchandani Individual Corporate DirectorBoard Member Jul 1, 2011
Scott B Davidson Individual Corporate DirectorDirector Sep 22, 2016
Randall W. Eberts Individual Corporate Director Jan 1, 2008
Brenda L Hunt Individual Corporate DirectorBoard Member Jul 1, 2011
Donald R. Parfet Individual Corporate Director Jan 1, 2008
Kirk Richardson Individual Corporate OfficerCoo, BLH Sep 1, 2016
James B Falahee Individual Corporate OfficerSVP Legal & Legislative Affairs Jun 1, 2014
W-2 Managing EmployeeSVP Legal & Legislative Affairs Jun 1, 2014
Neil Nyberg Individual Corporate DirectorBoard Member Jul 1, 2011
Nelson Karre Individual Corporate DirectorBoard Member Jul 1, 2011

Owners & managing parties with NPI records 7

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 11

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1356565170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 JOHN ST",
            "address_2": "BOX 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075295",
            "telephone_number": "269-341-7806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "451 HEALTH PKWY",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490798242",
            "telephone_number": "269-657-2550",
            "fax_number": "269-657-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON LAKEVIEW HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONSON LAKEVIEW HOSPITAL",
        "enumeration_date": "2007-04-12",
        "last_updated": "2023-11-27",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SVP, CFO",
        "authorized_official_telephone_number": "269-341-6000"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MI",
            "license": "80-0041",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bronson Lakeview Family Care-Paw Paw",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Bronson Lakeview Family Care-Paw Paw",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Paw Paw, MI

Sources for this page

Verify at the official NPI Registry.