NPIMap

Organization Active NPI

Lakeland Medical Practices

Doing business as Corewell Health Medical Group South

  • Internal Medicine Physician
  • Bridgman, MI
National Provider Identifier
1568232247
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
LAKELAND MEDICAL PRACTICES
Doing business as
Corewell Health Medical Group South
Practice address
9623 Red Arrow Hwy
Bridgman, MI 49106
Phone
(269) 465-6050
NPI assigned
Jan 4, 2024
Last updated
Jan 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Matthew E Cox
Title
Cfo
Phone
(616) 486-6790

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

9623 Red Arrow Hwy
Bridgman, MI 49106

Mailing address

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

Other names 1

  • Corewell Health Medical Group South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090928000216 MI Part B Supplier - Clinic/Group Practice 1658427042 Receives reassigned benefits from 798 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Joseph, MI; Stevensville, MI; Buchanan, MI; Niles, MI; Coloma, MI; Bridgman, MI; Berrien Springs, MI; Benton Harbor, MI

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Lakeland Medical Practice49 organizations share this tax ID, including this one

Other organizations with this tax ID 48

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

View all 48

Locations

9045 US Highway 31
Ste A
Berrien Springs, MI 49103
Phone (269) 473-2222

9623 Red Arrow Hwy
Bridgman, MI 49106
Phone (269) 465-6050

42 N Saint Joseph Ave
Ste 101
Niles, MI 49120
Phone (269) 687-4673

42 N Saint Joseph Ave
Ste 301
Niles, MI 49120
Phone (269) 428-0002

60 N Saint Joseph Ave
#C
Niles, MI 49120
Phone (269) 687-2910

3901 Stonegate Park
Ste 300
Saint Joseph, MI 49085
Phone (269) 408-4265

3904 Stonegate Park
Slp Pulmonary
Saint Joseph, MI 49085
Phone (269) 982-5964

3950 Hollywood Rd
Ste 230
Saint Joseph, MI 49085
Phone (269) 985-0000

5515 Cleveland Ave
Ste 1
Stevensville, MI 49127
Phone (269) 429-6604

5709 Saint Joseph Ave
Stevensville, MI 49127
Phone (269) 556-0930

Practitioners & affiliated clinicians

Practitioners 714

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.

View all 714

NPI Registry JSON

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

{
    "created_epoch": "1704326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1568232247",
    "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": "9623 RED ARROW HWY",
            "city": "BRIDGMAN",
            "state": "MI",
            "postal_code": "49106",
            "telephone_number": "269-465-6050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND MEDICAL PRACTICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-04",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-486-6790"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Medical Group South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bridgman, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; 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.