NPIMap

Organization Active NPI

Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
National Provider Identifier
1730133463
Registry record updated Jan 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation HospitalTaxonomy code 283X00000X
License
410070 Issued in MI
Legal business name
MARY FREE BED REHABILITATION HOSPITAL
Doing business as
Mary Free Bed Rehabilitation Hospital
Practice address
235 Wealthy SE
Grand Rapids, MI 49503-5299
Phone
(616) 242-0403
Fax
(616) 242-9113
NPI assigned
May 19, 2006
Last updated
Jan 27, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2022

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

Authorized official

Name
Mr. Ryan Podvin
Title
Cfo
Phone
(616) 840-8676

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Hospital 283X00000X 410070 MI Primary

Addresses

Primary practice location

235 Wealthy SE
Grand Rapids, MI 49503-5299

Mailing address

235 Wealthy SE
Grand Rapids, MI 49503-5299
Phone (616) 840-8676

Other identifiers 3

IdentifierTypeStateIssuer
101556008MedicaidMI
3996OtherPRIORITY HEALTH
233026OtherOSCAR

Other names 1

  • Mary Free Bed Rehabilitation Hospital Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040116000604 MI Part B Supplier - Clinic/Group Practice 4587576541 Receives reassigned benefits from 215 practitioners
3 other NPIs on this enrollment
Practice locations: Traverse City, MI; Wyoming, MI; Saginaw, MI; Norton Shores, MI; Kalamazoo, MI; Holland, MI; Grand Rapids, MI; Elk Rapids, MI
O20060224000705 MI Part A Provider - Hospital 4587576541 Practice locations: Grand Rapids, MI; Wyoming, MI; Norton Shores, MI; Holland, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1730133463. Details of each certification follow.

Hospital certification: CCN 233026

Legal name
MARY FREE BED REHABILITATION HOSPITAL
Doing business as
MARY FREE BED REHABILITATION HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Rehabilitation
Participating since
May 16, 1984
Last certification
Mar 11, 2009
Beds
167
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Incorporated
Mar 21, 1913 in MI
Enrollment address
235 Wealthy St SE
Grand Rapids, MI 49503-5247
Main/Primary Hospital Location
Hospital subgroups
Rehabilitation

Other NPIs on the same Medicare enrollment 3

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

Care Compare: Inpatient rehabilitation facility

Medicare Care Compare
Listed as
Mary Free Bed Rehabilitation HospitalCCN 233026 · All quality measures
Ownership
Non-profit
Certified
May 16, 1984
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory

Locations

1155 East Paris Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 233-3480

1787 Grand Ridge Ct NE
Ste 204
Grand Rapids, MI 49525
Phone (616) 447-8725

350 Lafayette Ave SE
Grand Rapids, MI 49503
Phone (616) 235-3984

412 Plymouth Ave NE
Ste 412
Grand Rapids, MI 49505
Phone (616) 840-8126

5500 Burton St SE
Grand Rapids, MI 49546
Phone (616) 285-9077

5500 Burton St SE
Ste B203
Grand Rapids, MI 49546
Phone (616) 840-8186

1362 S Pointe Rdg
Holland, MI 49423
Phone (616) 458-1187

2657 120th Ave
Holland, MI 49424
Phone (616) 395-0606

39475 Lewis Dr
Ste 290
Novi, MI 48377
Phone (248) 206-4457

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Mary Free Bed Guild of Grand Rapids Michigan Organization, Grand Rapids, MI Non-profit 5% Or Greater Direct Ownership Interest Dec 3, 1985 100%
Jeanne Skilton Individual Corporate Director Sep 26, 2017
Michael S Jakubowski Individual Corporate Director Aug 3, 2012
Gregory S Conway Individual Corporate Director Nov 22, 2011
James Moyer Individual Corporate Director Dec 15, 2011
Chad Bush Individual Corporate Director Jul 1, 2010
Judy Tamer Individual W-2 Managing EmployeeCredentialing Specialist Jan 4, 2021
Leanne Dimartino Individual W-2 Managing EmployeeMed Staff Manager May 17, 2021
Michael B Williams Individual Corporate Director Nov 22, 2011
Bruce Brasser Individual W-2 Managing Employee Oct 7, 2002
David Muir Individual Corporate Director Jul 1, 2010
Nathaniel Guzman Individual Corporate OfficerController Apr 1, 2021
Ellen Nelson Individual Corporate Director Sep 26, 2017
Michael T Andary Individual Corporate Director Jun 1, 2013
Susan Ellen Shannon Individual W-2 Managing EmployeeReimbursement Analyst Dec 1, 2017
Susan Taylor Individual Corporate DirectorBoard Member Aug 26, 2014
Kimberly Ridings Individual Corporate Director Jul 1, 2010
Margaret Nault Individual Corporate Director Sep 26, 2017
Judy Dunten Individual Corporate Director Sep 26, 2017
Laura L Puff Individual Corporate Director Sep 26, 2017
Carol M Springer Individual Corporate DirectorBoard Member Aug 26, 2014
Julie M Ridenour Individual Corporate Director Feb 24, 2006
Kent R Riddle Individual Corporate Director Feb 24, 2006
Scott Lewis Individual Corporate Director Sep 26, 2017
Roger W Spoelman Individual Corporate DirectorBoard Member Jun 1, 2013
Ingrid Cheslek Individual Corporate Director Sep 26, 2017
Dianne Deroseau Individual Corporate Director Sep 26, 2017
Molly Krauss Individual Corporate Director Jul 1, 2010
Holly Marie Peterson Individual Corporate Director Sep 26, 2017
Ryan T Podvin Individual Corporate DirectorCfo Apr 1, 2021
Michele L Suchovsky Individual Corporate Director Sep 26, 2017

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 4

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

FacilityTypeRoleSince
The Carle Foundation HospitalUrbana, IL, CCN 14T091 Hospital Operational/Managerial Control Nov 7, 2025
Carle Bromenn Medical CenterNormal, IL, CCN 14T127 Hospital Operational/Managerial Control Nov 7, 2025
Mary Free Bed Sub-Acute RehabilitationGrand Rapids, MI, CCN 235708 Skilled nursing facility 5% Or Greater Indirect Ownership Interest (50%) Jul 1, 2015
Mary Free Bed at Home, LLCGrand Rapids, MI, CCN 237203 Home health agency 5% Or Greater Indirect Ownership Interest (60%) Jun 1, 2016

Owned or controlled facilities with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 245

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 245

Affiliated clinicians 123

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

View all 123

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1643241600000",
    "number": "1730133463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035299",
            "telephone_number": "616-840-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035299",
            "telephone_number": "616-242-0403",
            "fax_number": "616-242-9113"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY FREE BED REHABILITATION HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2022-01-27",
        "certification_date": "2022-01-27",
        "status": "A",
        "authorized_official_last_name": "PODVIN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-840-8676",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "283X00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Hospital",
            "state": "MI",
            "license": "410070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101556008",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "3996",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OSCAR",
            "identifier": "233026",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Free Bed Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary Free Bed Rehabilitation Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.