NPIMap

Organization Active NPI

Lakeland Community Hospital Watervliet

Doing business as Corewell Health Watervliet Hospital

  • General Acute Care Hospital
  • Watervliet, MI
National Provider Identifier
1700994845
Registry record updated Dec 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
LAKELAND COMMUNITY HOSPITAL WATERVLIET
Doing business as
Corewell Health Watervliet Hospital
Watervliet Professional Group
Practice address
400 Medical Park Dr
Watervliet, MI 49098-9225
Phone
(269) 983-8300
Fax
(269) 982-4855
NPI assigned
Aug 28, 2006
Last updated
Dec 17, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
COREWELL HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 17, 2023

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

Authorized official

Name
Matthew Cox
Title
Cfo
Phone
(616) 915-3777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X NU Primary

Addresses

Primary practice location

400 Medical Park Dr
Watervliet, MI 49098-9225

Mailing address

400 Medical Park Dr
Watervliet, MI 49098-9225
Phone (269) 983-8300

Other identifiers 3

IdentifierTypeStateIssuer
30 1556886MedicaidMI
00184OtherMIBCBSM
40 5170415MedicaidMI

Other names 2

  • Corewell Health Watervliet Hospital Doing business as
  • Watervliet Professional Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20081120000739 MI Part A Provider - Hospital 7416942750 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Watervliet, MI
O20101015000129 MI Part A Provider - Hospital 7416942750 Practice locations: Niles, MI; Watervliet, MI; Coloma, MI
O20140729001948 MI Part B Supplier - Clinic/Group Practice 8729245584 Receives reassigned benefits from 71 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Portage, MI; Three Rivers, MI; White Pigeon, MI

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1700994845. Details of each certification follow.

Hospital certification: CCN 23T078

Legal name
LAKELAND COMMUNITY HOSPITAL WATERVLIET
Doing business as
COREWELL HEALTH WATERVLIET HOSPITAL
Organization structure
CorporationNon-profit
Enrollment address
400 Medical Park Dr
Watervliet, MI 49098-9225
Hospital Rehabilitation Unit
Hospital subgroups
Rehabilitation unit

Hospital certification: CCN 230078

Legal name
LAKELAND COMMUNITY HOSPITAL WATERVLIET
Doing business as
COREWELL HEALTH WATERVLIET HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
May 17, 1997
Beds
62
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1947 in MI
Enrollment address
400 Medical Park Dr
Watervliet, MI 49098-9225
Main/Primary Hospital Location
Hospital subgroups
Acute care

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).

Other NPIs on the same Medicare enrollment 24

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

View all 24

Care Compare: Hospital

Medicare Care Compare
Listed as
Corewell Health Watervliet HospitalCCN 230078 · All quality measures
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Community Rehabilitation CenterCCN 23T078 · All quality measures
Ownership
Non-profit
Certified
Oct 1, 1992

National Provider Directory

National Provider Directory
Part of
Corewell Health East

Locations

400 Medical Park Dr
#200
Watervliet, MI 49098

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Whitney Eckhoff Individual W-2 Managing EmployeeManager, Provider Enrollment Oct 1, 2023
W-2 Managing EmployeeManager,, Provider Enrollment Jul 1, 2024
Kenneth Oneill Individual Corporate DirectorBoard Member Jan 1, 2022
Jerry French Individual Corporate DirectorBoard Member Jan 1, 2024
Christina Freese Decker Individual Corporate OfficerPresident & Ceo Corewell Health Feb 1, 2022
Pamela Garmon Johnson Individual Corporate DirectorBoard Member Jan 1, 2022
Deborah L Bennett Berecz Individual Corporate DirectorBoard Member Jan 1, 2023
Scott Smith Individual Corporate DirectorBoard Member Jan 1, 2022
Corporate DirectorBoard Member Jan 1, 2008
Amey Upton Individual Corporate DirectorBoard Member Mar 24, 2024
Dana Wales Individual Corporate DirectorBoard Member Jan 1, 2023
Matthew E Cox Individual Corporate OfficerChief Financial Officer Nov 2, 2022
Operational/Managerial ControlChief Financial Officer Nov 2, 2022
Corporate DirectorChief Financial Officer Nov 1, 2022
Operational/Managerial ControlChief Financial Officer Jan 1, 2022 100%
Corewell Health Organization, Grand Rapids, MI Corporation, Non-profit, Chain home office Operational/Managerial Control Oct 1, 2018 100%
Operational/Managerial Control Feb 1, 2022 100%
Bertha King Individual Corporate OfficerBoard Member Aug 29, 2023
Corporate DirectorBoard Member Aug 29, 2023
Stephen L Hempel Individual Corporate DirectorBoard Member Jan 1, 2024
Christine Vanlandingham Individual Corporate DirectorBoard Member Jan 1, 2020
Corporate DirectorBoard Member Jan 27, 2010
Carey Martin Individual Corporate DirectorBoard Member Jan 1, 2022
Tamila Marlow Individual W-2 Managing EmployeeRevenue Cycle MGR, Fiss Access Oct 15, 2021
W-2 Managing EmployeeManager, Revenue Cycle Oct 15, 2021
David Schaffer Individual Corporate DirectorBoard Member Jan 1, 2022
George Heenan Individual Corporate DirectorBoard Member Jan 1, 2022

Facilities with the same owner 66

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

View all 66

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 237

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 237

NPI Registry JSON

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

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702771200000",
    "number": "1700994845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-983-8300",
            "fax_number": "269-982-4855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 MEDICAL PARK DR",
            "city": "WATERVLIET",
            "state": "MI",
            "postal_code": "490989225",
            "telephone_number": "269-983-8300",
            "fax_number": "269-982-4855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKELAND COMMUNITY HOSPITAL WATERVLIET",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COREWELL HEALTH",
        "enumeration_date": "2006-08-28",
        "last_updated": "2023-12-17",
        "certification_date": "2023-12-17",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-915-3777"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30 1556886",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "00184",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40 5170415",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Watervliet Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Watervliet Professional Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watervliet, MI

Sources for this page

Verify at the official NPI Registry.