NPIMap

Bronson Lakeview Hospital

Organization Active NPI Rural Health Clinic/Center · South Haven, MI

NPI 1801538871 · NPPES record last updated Apr 11, 2022

Key facts

NPI
1801538871
Entity type
Organization (NPI type 2)
Primary specialty
Rural Health Clinic/Center 261QR1300X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Practice address
930 Blue Star Hwy
South Haven, MI 49090-7758
Phone
(269) 637-1115
Fax
(269) 639-1314
NPI assigned
Apr 11, 2022
Organization subpart
Yes
Parent organization (as reported)
BRONSN LAKEVIEW HOSPITAL

Authorized official

Name
Rebecca East
Title
Cfo
Phone
(269) 341-6000

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) 2

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

Facilities with the same owner 11

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

Practitioners 302

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

View all 302

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
23D2138397Bronson Family Medicine - Blue Star
930 Blue Star Highway, South Haven, MI 49090		Certificate of waiverJun 15, 2028

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MI

Rural health clinic certification: CCN 238770

Legal name
BRONSON LAKEVIEW HOSPITAL
Doing business as
BRONSON LAKEVIEW FAMILY CARE - BLUE STAR
Organization structure
Corporation · Non-profit
Incorporated
Oct 25, 2007 in MI
Enrollment address
930 Blue Star Hwy
South Haven, MI 49090-7758

All disclosed owners & managing parties 27

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

NameRoleSinceShare
Bill Harold Manns
Individual 		Corporate Officer
President & Ceo		 Jan 1, 2020
William B Workman
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Rebecca East
Individual 		Corporate Officer
SVP, Cfo		 Jan 1, 2015
Lajune Montgomery-Tabron
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Michael F Odar
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Steven J Lins
Individual 		Corporate Director
Chief of Staff		 Jan 1, 2011
Barbara L James
Individual 		Corporate Director
Board Member		 Jan 1, 2000
Erick Stewart
Individual 		Corporate Director
Board Member		 Nov 1, 2022
James L Liggins
Individual 		Corporate Director
Board Member		 Jan 1, 2016
Leigh Ann Colegrove
Individual 		W-2 Managing Employee
System Credentialing Coordinator		 Oct 11, 2021
Lynn Chen-Zhang
Individual 		Corporate Director
Board Member		 Nov 1, 2022
William D Johnston
Individual 		Corporate Director
Board Member		 Jan 1, 2009
Jorge Gonzalez
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Namita Sharma
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Richard J Allen
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Bronson Health Care Group Inc
Organization · Kalamazoo, MI
Corporation, Non-profit 		5% Or Greater Direct Ownership Interest Jul 1, 2022 100%
Operational/Managerial Control Jul 1, 2022 100%
Scott Larson
Individual 		Corporate Officer
Cmo		 Jan 1, 1995
Mary Fink
Individual 		Corporate Director
Board Member		 Jan 1, 2017
Scott C Gibson
Individual 		Corporate Director
Board Member		 Jan 1, 2006
Luther Marshall Washington
Individual 		Corporate Director
Board Member		 Nov 1, 2022
Mahesh C Karamchandani
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Randall W. Eberts
Individual 		Corporate Director
Vice Chair		 Jan 1, 1999
Brenda L Hunt
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Donald R. Parfet
Individual 		Corporate Director
Board Member		 Jan 1, 1986
James B Falahee
Individual 		Corporate Officer
Chief Legal Officer		 Jan 1, 1995
Neil Nyberg
Individual 		Corporate Director
Board Member		 Jan 1, 2011
Nelson Karre
Individual 		Corporate Director
Chair		 Jan 1, 2011

Change-of-ownership history

DateEventCounterparty
Jul 1, 2022 Change of Ownership
This provider was the buyer		 Bronson Family Medicine - Blue Star
CCN 238939 · MI · NPI 1871104034

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20220627002222 MI Part a Provider - Rural Health Clinic 9032008495 Practice locations: South Haven, MI

National Provider Directory

Tax ID family
Lake View Community Hos (3 organizations share this tax ID)
Part of
Lake View Community Hos

Locations

209 W Delaware St
Decatur, MI 49045
Phone (269) 423-8510

310 White Oak Rd
Lawton, MI 49065
Phone (269) 624-2031

451 Health Pkwy
Ste A
Paw Paw, MI 49079
Phone (269) 655-3065

451 Health Pkwy
Ste B
Paw Paw, MI 49079
Phone (269) 655-3065

822 E Michigan Ave
Paw Paw, MI 49079
Phone (269) 657-2800

1021 Hill St
Three Rivers, MI 49093
Phone (269) 273-8511

Specialties & licenses

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

Addresses

Primary practice location

930 Blue Star Hwy
South Haven, MI 49090-7758

Mailing address

301 John St # 42
Kalamazoo, MI 49007-5295
Phone (269) 341-8536

Other names

  • Bronson LakeView Family Care-Blue Star Doing business as

Electronic endpoints

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Other providers in South Haven, MI

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

Sources for this page

Verify at the official NPI Registry.