NPIMap

Organization Active NPI

Mecosta County Medical Center

Doing business as Corewell Health Big Rapids Hospital Family Medicine - Evart

  • Rural Health Clinic/Center
  • Evart, MI
National Provider Identifier
1669935615
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
MECOSTA COUNTY MEDICAL CENTER
Doing business as
Corewell Health Big Rapids Hospital Family Medicine - Evart
Spectrum Health Big Rapids Hospital Family Medicine Evart
Practice address
5991 95TH Ave
Evart, MI 49631-9386
Phone
(231) 832-8700
NPI assigned
Apr 8, 2019
Last updated
Aug 22, 2023By the provider in NPPES
Organization subpart
No

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
Amanda Knuth
Title
Controller
Phone
(231) 349-1616

Specialties & licenses 1

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

Addresses

Primary practice location

5991 95TH Ave
Evart, MI 49631-9386

Mailing address

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

Other names 2

  • Corewell Health Big Rapids Hospital Family Medicine - Evart Doing business as
  • Spectrum Health Big Rapids Hospital Family Medicine Evart Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190717000133 MI Part A Provider - Rural Health Clinic 1951215540 Practice locations: Evart, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669935615. Details of each certification follow.

Rural health clinic certification: CCN 238594

Legal name
MECOSTA COUNTY MEDICAL CENTER
Doing business as
COREWELL HEALTH BIG RAPIDS HOSPITAL FAMILY MEDICINE-EVART
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 31, 2004
Last certification
Nov 26, 2019
Ownership / control type
2B
Most recent change of ownership
Jun 28, 2019 (1 total)
Organization structure
CorporationNon-profit
Enrollment address
5991 95TH Ave
Evart, MI 49631-9386
Related CCNs
230093

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
23D0381065Corewell Health Big Rapids Hospital Family5991 S 95TH Avenue, Evart, MI 49631Certificate of waiverNov 2, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mecosta County Med Center15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

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 & Ceo Sep 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 Operational/Managerial Control Jan 1, 2000
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

Change-of-ownership history 1

DateEventCounterparty
Jun 28, 2019 Change of OwnershipThis provider was the buyer Spectrum Health Reed City Hospital Evart Family PracticeCCN 238594, MI, NPI 1538265343

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

NPI Registry JSON

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1669935615",
    "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": "5991 95TH AVE",
            "city": "EVART",
            "state": "MI",
            "postal_code": "496319386",
            "telephone_number": "231-832-8700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECOSTA COUNTY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-08",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "KNUTH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "231-349-1616"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Big Rapids Hospital Family Medicine - Evart",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Big Rapids Hospital Family Medicine Evart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Evart, MI

Sources for this page

Verify at the official NPI Registry.