NPIMap

Organization Active NPI

Newaygo County General Hospital Association

Doing business as Corewell Health Gerber Hospital Family Medicine - Newaygo

  • Rural Health Clinic/Center
  • Newaygo, MI
National Provider Identifier
1467845537
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 Family Medicine - Newaygo
Spectrum Health Gerber Memorial Family Medicine Newaygo
Practice address
211 W Pine Lake Dr
Newaygo, MI 49337-8029
Phone
(231) 652-1631
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
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

211 W Pine Lake Dr
Newaygo, MI 49337-8029

Mailing address

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

Other names 2

  • Corewell Health Gerber Hospital Family Medicine - Newaygo Doing business as
  • Spectrum Health Gerber Memorial Family Medicine Newaygo Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150512001826 MI Part A Provider - Rural Health Clinic 4880503051 Practice locations: Newaygo, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1467845537. Details of each certification follow.

Rural health clinic certification: CCN 238685

Legal name
NEWAYGO COUNTY GENERAL HOSPITAL ASSOCIATION
Doing business as
COREWELL HEALTH GERBER HOSPITAL FAMILY MEDICINE-NEWAYGO
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Sep 9, 2015
Last certification
Sep 9, 2015
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
211 W Pine Lake Dr
Newaygo, MI 49337-8029
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
23D0900778Corewell Health Gerber Hospital Family211 W Pine Lake Drive, Newaygo, MI 49337Certificate of waiverMay 10, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gerber Memorial Hospital15 organizations share this tax ID, including this one
Part of
Gerber Memorial Hospital

Other organizations with this tax ID 14

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

View all 14

Locations

230 W Oak St
Ste 201
Fremont, MI 49412
Phone (231) 924-4200

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 Oct 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 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 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 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": "1467845537",
    "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": "211 W PINE LAKE DR",
            "city": "NEWAYGO",
            "state": "MI",
            "postal_code": "493378029",
            "telephone_number": "231-652-1631"
        }
    ],
    "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": "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Gerber Hospital Family Medicine - Newaygo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Gerber Memorial Family Medicine Newaygo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Gerber Memorial Family Medicine Newaygo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newaygo, MI

Sources for this page

Verify at the official NPI Registry.