NPIMap

Mecosta County Medical Center

Organization Active NPI Rural Health Clinic/Center · Evart, MI

NPI 1669935615 · NPPES record last updated Aug 22, 2023

Key facts

NPI
1669935615
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
MECOSTA COUNTY MEDICAL CENTER
Practice address
5991 95TH Ave
Evart, MI 49631-9386
Phone
(231) 832-8700
NPI assigned
Apr 8, 2019
Organization subpart
No

Authorized official

Name
Amanda Knuth
Title
Controller
Phone
(231) 349-1616

Owners & managing parties with NPI records 5

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

Other NPIs with the same Medicare PAC ID 5

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

Corporate family (same tax ID) 14

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

Facilities connected through Provider of Services related, parent or unit certification numbers.

Change of ownership 1

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

Facilities with the same owner 66

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 66

Practitioners 53

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 53

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0381065Corewell Health Big Rapids Hospital Family
5991 S 95TH Avenue, Evart, MI 49631		Certificate of waiverNov 2, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

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
Corporation · Non-profit
Enrollment address
5991 95TH Ave
Evart, MI 49631-9386
Related CCNs
230093

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
Other
President & 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 Officer
SVP 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

Change-of-ownership history

DateEventCounterparty
Jun 28, 2019 Change of Ownership
This provider was the buyer		 Spectrum Health Reed City Hospital Evart Family Practice
CCN 238594 · MI · NPI 1538265343

Medicare enrollment records

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

National Provider Directory

Tax ID family
Mecosta Cnty General Hosp (15 organizations share this tax ID)

Specialties & licenses

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

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

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

Other providers in Evart, MI

All providers in Evart, MI · Rural Health Clinic/Center in Michigan

Sources for this page

Verify at the official NPI Registry.