NPIMap

Organization Active NPI

Memorial Medical Center of West Michigan

Doing business as Corewell Health Ludington Hospital Pediatrics

  • Rural Health Clinic/Center
  • Ludington, MI
National Provider Identifier
1538528872
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 Pediatrics
Spectrum Health Ludington Hospital Pediatrics - Ludington
Practice address
907 E Tinkham Ave
Ludington, MI 49431-1537
Phone
(231) 843-3477
NPI assigned
Feb 15, 2016
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
President
Phone
(616) 802-0206

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

907 E Tinkham Ave
Ludington, MI 49431-1537

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 2

  • Corewell Health Ludington Hospital Pediatrics Doing business as
  • Spectrum Health Ludington Hospital Pediatrics - Ludington Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170111001180 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 1538528872. Details of each certification follow.

Rural health clinic certification: CCN 238702

Legal name
MEMORIAL MEDICAL CENTER OF WEST MICHIGAN
Doing business as
COREWELL HEALTH LUDINGTON HOSPITAL PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 16, 2017
Last certification
Jul 17, 2025
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
907 E Tinkham Ave
Ludington, MI 49431-1537
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
23D0379584Corewell Health Ludington Hospital Pediatrics907 E Tinkham Avenue, Ludington, MI 49431Certificate of waiverApr 28, 2028

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

Locations

907 E Tinkham Ave
Ludington, MI 49431
Phone (231) 843-3477

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 OtherPresident and Ceo 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 Oct 1, 2013
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 Sep 1, 2020

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": "1455494400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692748800000",
    "number": "1538528872",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 E TINKHAM AVE",
            "city": "LUDINGTON",
            "state": "MI",
            "postal_code": "494311537",
            "telephone_number": "231-843-3477"
        }
    ],
    "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": "2016-02-15",
        "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": "PRESIDENT",
        "authorized_official_telephone_number": "616-802-0206"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "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 Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Ludington Hospital Pediatrics - Ludington",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Ludington Hospital Pediatrics - Ludington",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Ludington, MI

Sources for this page

Verify at the official NPI Registry.