NPIMap

Organization Active NPI

Bronson Lakeview Hospital

Doing business as Bronson LakeView Family Care-Blue Star

  • Rural Health Clinic/Center
  • South Haven, MI
National Provider Identifier
1801538871
Registry record updated Apr 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Doing business as
Bronson LakeView Family Care-Blue Star
Practice address
930 Blue Star Hwy
South Haven, MI 49090-7758
Phone
(269) 637-1115
Fax
(269) 639-1314
NPI assigned
Apr 11, 2022
Last updated
Apr 11, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
BRONSN LAKEVIEW HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2022

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

Authorized official

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

Specialties & licenses 1

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

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 1

  • Bronson LakeView Family Care-Blue Star Doing business as

Electronic endpoints 1

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

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1801538871. Details of each certification follow.

Rural health clinic certification: CCN 238770

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

Rural health clinic certification: CCN 238939

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
BRONSON LAKEVIEW FAMILY CARE-BLUE STAR
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 3, 2021
Last certification
Mar 3, 2021
Ownership / control type
2B
Facility address
930 Blue Star Hwy
South Haven, MI 49090

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
23D2138397Bronson Family Medicine - Blue Star930 Blue Star Highway, South Haven, MI 49090Certificate of waiverJun 15, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lakeview Comm Hospital3 organizations share this tax ID, including this one
Part of
Lakeview Comm Hospital

Other organizations with this tax ID 2

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

Locations

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

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

404 Hazen St
Ste 100
Paw Paw, MI 49079
Phone (269) 341-8827

451 Health Pkwy
Ste E
Paw Paw, MI 49079
Phone (269) 655-3063

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

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

Ownership & related parties

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 OfficerPresident & Ceo Jan 1, 2020
William B Workman Individual Corporate DirectorBoard Member Nov 1, 2022
Rebecca East Individual Corporate OfficerSVP, Cfo Jan 1, 2015
Lajune Montgomery-Tabron Individual Corporate DirectorBoard Member Jan 1, 2011
Michael F Odar Individual Corporate DirectorBoard Member Jan 1, 2016
Steven J Lins Individual Corporate DirectorChief of Staff Jan 1, 2011
Barbara L James Individual Corporate DirectorBoard Member Jan 1, 2000
Erick Stewart Individual Corporate DirectorBoard Member Nov 1, 2022
James L Liggins Individual Corporate DirectorBoard Member Jan 1, 2016
Leigh Ann Colegrove Individual W-2 Managing EmployeeSystem Credentialing Coordinator Oct 11, 2021
Lynn Chen-Zhang Individual Corporate DirectorBoard Member Nov 1, 2022
William D Johnston Individual Corporate DirectorBoard Member Jan 1, 2009
Jorge Gonzalez Individual Corporate DirectorBoard Member Jan 1, 2017
Namita Sharma Individual Corporate DirectorBoard Member Nov 1, 2022
Richard J Allen Individual Corporate DirectorBoard 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 OfficerCmo Jan 1, 1995
Mary Fink Individual Corporate DirectorBoard Member Jan 1, 2017
Scott C Gibson Individual Corporate DirectorBoard Member Jan 1, 2006
Luther Marshall Washington Individual Corporate DirectorBoard Member Nov 1, 2022
Mahesh C Karamchandani Individual Corporate DirectorBoard Member Jan 1, 2011
Randall W. Eberts Individual Corporate DirectorVice Chair Jan 1, 1999
Brenda L Hunt Individual Corporate DirectorBoard Member Jan 1, 2011
Donald R. Parfet Individual Corporate DirectorBoard Member Jan 1, 1986
James B Falahee Individual Corporate OfficerChief Legal Officer Jan 1, 1995
Neil Nyberg Individual Corporate DirectorBoard Member Jan 1, 2011
Nelson Karre Individual Corporate DirectorChair Jan 1, 2011

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 11

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

Change-of-ownership history 1

DateEventCounterparty
Jul 1, 2022 Change of OwnershipThis provider was the buyer Bronson Family Medicine - Blue StarCCN 238939, MI, NPI 1871104034

Practitioners & affiliated clinicians

Practitioners 299

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 299

NPI Registry JSON

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

{
    "created_epoch": "1649635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649635200000",
    "number": "1801538871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 JOHN ST # 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075295",
            "telephone_number": "269-341-8536",
            "fax_number": "269-341-8913"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 BLUE STAR HWY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "490907758",
            "telephone_number": "269-637-1115",
            "fax_number": "269-639-1314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON LAKEVIEW HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BRONSN LAKEVIEW HOSPITAL",
        "enumeration_date": "2022-04-11",
        "last_updated": "2022-04-11",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "269-341-6000"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Bronson LakeView Family Care-Blue Star",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Haven, MI

Sources for this page

Verify at the official NPI Registry.