NPIMap

Organization Active NPI

Community Health Center of Branch County

Doing business as CHC Viking Connect

  • Pediatric Adolescent Medicine Physician
  • Bronson, MI
National Provider Identifier
1467889386
Registry record updated Oct 9, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X
Legal business name
COMMUNITY HEALTH CENTER OF BRANCH COUNTY
Doing business as
CHC Viking Connect
Practice address
450 E Grant St
Bronson, MI 49028-1524
Phone
(517) 279-5296
NPI assigned
Oct 9, 2013
Last updated
Oct 9, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2013

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

Authorized official

Name
Randall Degroot
Title
President/Ceo
Phone
(517) 279-5489

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Adolescent Medicine Physician 2080A0000X NU Primary

Addresses

Primary practice location

450 E Grant St
Bronson, MI 49028-1524

Mailing address

274 E Chicago St
Coldwater, MI 49036-2041
Phone (517) 279-5400

Other names 1

  • CHC Viking Connect Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040309000671 MI Part B Supplier - Clinic/Group Practice 9335037514 Receives reassigned benefits from 162 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Coldwater, MI; Union City, MI; Quincy, MI; Litchfield, MI; Bronson, MI

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Vician Elena MD19 organizations share this tax ID, including this one

Other organizations with this tax ID 18

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

View all 18

Locations

450 E Grant St
Bronson, MI 49028
Phone (517) 279-5296

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1381276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381276800000",
    "number": "1467889386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "274 E CHICAGO ST",
            "city": "COLDWATER",
            "state": "MI",
            "postal_code": "490362041",
            "telephone_number": "517-279-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 E GRANT ST",
            "city": "BRONSON",
            "state": "MI",
            "postal_code": "490281524",
            "telephone_number": "517-279-5296"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY HEALTH CENTER OF BRANCH COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-09",
        "last_updated": "2013-10-09",
        "status": "A",
        "authorized_official_last_name": "DEGROOT",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "517-279-5489"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CHC Viking Connect",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bronson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2013; 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.