NPIMap

Organization Active NPI

Catherine's Health Center

Doing business as Catherine's Health Center - Crestwood

  • Federally Qualified Health Center (FQHC)
  • Kentwood, MI
National Provider Identifier
1881463958
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATHERINE'S HEALTH CENTER
Doing business as
Catherine's Health Center - Crestwood
Practice address
2674 44TH St SE
Kentwood, MI 49512-3804
Phone
(616) 336-8800
NPI assigned
Dec 29, 2023
Last updated
Dec 29, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Authorized official

Name
Sara Brooks
Title
Director of Operations
Phone
(616) 336-8800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary

Addresses

Primary practice location

2674 44TH St SE
Kentwood, MI 49512-3804

Mailing address

950 36TH St SW
Wyoming, MI 49509-3587

Other names 1

  • Catherine's Health Center - Crestwood Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240122002433 MI Part A Provider - Federally Qualified Health Center (FQHC) 2860615838 Practice locations: Kentwood, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1881463958. Details of each certification follow.

Federally qualified health center certification: CCN C71015

Legal name
CATHERINE'S HEALTH CENTER
Doing business as
CATHERINE'S HEALTH CENTER - CRESTWOOD
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 17, 2024
Last certification
Jan 17, 2024
Ownership / control type
For profit – corporation
Organization structure
OtherNon-profit
Enrollment address
2674 44TH St SE
Kentwood, MI 49512-3804

Other NPIs with the same Medicare PAC ID 13

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

View all 13

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
23D2302900Catherine's Health Center at2674 44TH Street SE, Kentwood, MI 49512Certificate of waiverApr 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Catherine's Health Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

2674 44th St SE
Kentwood, MI 49512

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Kenneth S Johnson Individual Corporate Officer Jan 1, 2023
Yvonne George Individual Corporate Officer Jan 1, 2023
Sara Brooks Individual Corporate Director Oct 4, 2021
Dustin Maynes Individual Corporate Director Jan 1, 2021
Adrienne Goodstal Individual Corporate Officer Jan 1, 2023
Allison Shook Individual Corporate Director Jan 1, 2022
Cole Sweda Individual Corporate Director Jan 1, 2024
Catherine Kelly Individual Corporate Officer Jan 1, 2023
Megan Erskine Individual Corporate Officer Apr 12, 2022
W-2 Managing Employee Apr 12, 2022
Mark a Contreras Individual Corporate Director Jan 1, 2021
William Williams Individual Corporate Officer Jan 1, 2023
Andrea Cosier Individual Corporate Officer Jan 1, 2023
Alisha Davis Individual Corporate Officer Jan 1, 2023
Rick Schuitema Individual Corporate Director Jan 1, 2024

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 3

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

FacilityTypeRoleSince
Catherine's Health Dental CenterGrand Rapids, MI, CCN 231163 Federally qualified health center Operational/Managerial Control (100%) Aug 11, 2005
Catherine's Health Center - Mel TrotterGrand Rapids, MI, CCN C71009 Federally qualified health center Operational/Managerial Control (100%) Nov 8, 2023
Catherine's Health Center - CrossroadsGrand Rapids, MI, CCN C71013 Federally qualified health center Operational/Managerial Control (100%) Dec 29, 2023

Owned or controlled facilities with NPI records 3

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

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1703808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1881463958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 36TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495093587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2674 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495123804",
            "telephone_number": "616-336-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHERINE'S HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-29",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "SARA",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "616-336-8800"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catherine's Health Center - Crestwood",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kentwood, MI

Sources for this page

Verify at the official NPI Registry.