NPIMap

Organization Active NPI

Catherines Health Center

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
National Provider Identifier
1669074415
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATHERINES HEALTH CENTER
Practice address
280 60TH St SE Ste 200
Grand Rapids, MI 49548-8504
Phone
(616) 336-8800
Fax
(616) 336-9700
NPI assigned
Nov 16, 2020
Last updated
Dec 28, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
CATHERINES HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Authorized official

Name
Karen Kaashoek
Title
Executive Director
Phone
(616) 336-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

280 60TH St SE Ste 200
Grand Rapids, MI 49548-8504

Mailing address

1211 Lafayette Ave NE
Grand Rapids, MI 49505-5092
Phone (616) 336-8800

Other names 1

  • Catherine's Health Center at Streams of Hope Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20140520000626 MI Part B Supplier - Clinic/Group Practice 2860615838 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wyoming, MI; Grand Rapids, MI
O20210114000532 MI Part A Provider - Federally Qualified Health Center (FQHC) 2860615838 Practice locations: Grand Rapids, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669074415. Details of each certification follow.

Federally qualified health center certification: CCN 231164

Legal name
CATHERINE'S HEALTH CENTER
Doing business as
CATHERINE'S HEALTH CENTER STREAMS OF HOPE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 14, 2021
Last certification
Jan 14, 2021
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
280 60TH St SE
Grand Rapids, MI 49548-8504

Other NPIs with the same Medicare PAC ID 13

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 13

Other NPIs on the same Medicare enrollment 5

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

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
23D2214038Catherine's Health Center at Streams of Hope280 60TH St SE Suite 200, Grand Rapids, MI 49548Certificate of waiverFeb 17, 2027

National Provider Directory

National Provider Directory
Part of
Catherine's Health Center

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Kenneth S Johnson Individual Corporate Director Jan 1, 2023 7.69%
Yvonne George Individual Corporate Director Jan 1, 2022 7.69%
Sara Brooks Individual W-2 Managing EmployeeAd; Oct 4, 2021
Dustin Maynes Individual W-2 Managing EmployeeAd; Jan 1, 2021
Adrienne Goodstal Individual Corporate OfficerVice President, Board of Directors Jan 1, 2023 7.69%
Allison Shook Individual W-2 Managing EmployeeAd; Jan 1, 2022
Cole Sweda Individual Corporate Director Jan 1, 2024 7.69%
Jade Kennedy Individual Corporate Officer Jan 1, 2026
Catherine Kelly Individual Corporate Director Jan 1, 2023 7.69%
Zandra Vazquez Individual Corporate Officer Jan 1, 2026
Megan Erskine Individual Corporate Officer Apr 12, 2022
W-2 Managing Employee Apr 12, 2022
Mark a Contreras Individual W-2 Managing EmployeeMD; Jan 1, 2021
William Williams Individual Corporate Director Jan 1, 2023 7.69%
Andrea Cosier Individual Corporate Director Jan 1, 2023 7.69%
Alisha Davis Individual Corporate Director Jan 1, 2023 7.69%
Rick Schuitema Individual Corporate OfficerTreasurer, Board of Directors Jan 1, 2024 7.69%

Owners & managing parties with NPI records 2

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Catherine's Health Dental CenterGrand Rapids, MI, CCN 231163 Federally qualified health center Operational/Managerial Control (100%) Aug 11, 2005
Catherine's Health Center - Mel TrotterGrand Rapids, MI, CCN C71009 Federally qualified health center Operational/Managerial Control (100%) Nov 8, 2023
Catherine's Health Center - CrossroadsGrand Rapids, MI, CCN C71013 Federally qualified health center Operational/Managerial Control (100%) Dec 29, 2023

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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.

Practitioners & affiliated clinicians

Practitioners 8

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": "1605484800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609113600000",
    "number": "1669074415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055092",
            "telephone_number": "616-336-8800",
            "fax_number": "616-336-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 60TH ST SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495488504",
            "telephone_number": "616-336-8800",
            "fax_number": "616-336-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHERINES HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATHERINES HEALTH CENTER",
        "enumeration_date": "2020-11-16",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A",
        "authorized_official_last_name": "KAASHOEK",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-336-8800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catherine's Health Center at Streams of Hope",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Catherine's Health Center at Streams of Hope",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.