NPIMap

Organization Active NPI

Mecosta County Medical Center

  • Rural Health Clinic/Center
  • Big Rapids, MI
National Provider Identifier
1891109591
Registry record updated Aug 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MECOSTA COUNTY MEDICAL CENTER
Practice address
722 Locust St
Ste 2
Big Rapids, MI 49307-2040
Phone
(231) 592-4200
Fax
(231) 527-6859
NPI assigned
Jun 20, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2023

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

Authorized official

Name
Amanda Knuth
Title
Cfo
Phone
(231) 349-1616

Specialties & licenses 1

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

Addresses

Primary practice location

722 Locust St
Ste 2
Big Rapids, MI 49307-2040

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 2

  • Corewell Health Big Rapids Hospital Obstetrics, Gynecology & Urology - Doing business as
  • Spectrum Health Big Rapids Obstetrics, Gynecology and Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20141215002273 MI Part A Provider - Rural Health Clinic 1951215540 Practice locations: Big Rapids, MI

Rural health clinic certification: CCN 238677

Legal name
MECOSTA COUNTY MEDICAL CENTER
Doing business as
COREWELL HEALTH BIG RAPIDS HOSPITAL OBSTETRICS, GYNECOLOGY & UROLOGY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Apr 16, 2015
Last certification
Apr 16, 2015
Ownership / control type
2A
Organization structure
CorporationNon-profit
Enrollment address
722 Locust St
Ste 2
Big Rapids, MI 49307-2040
Related CCNs
230093

Facilities connected through Provider of Services related, parent or unit certification numbers.

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
23D2037532Corewell Health Big Rapids Hospital Obstetrics,722 Locust Street, Big Rapids, MI 49307Provider-performed microscopyApr 1, 2027

National Provider Directory

National Provider Directory
Tax ID family
Mecosta Cnty General Hosp15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Christina Freese Decker Individual Corporate Director Aug 18, 2020
Talawnda L Bragg Individual Corporate Director Jan 1, 2022
Christopher B Port Individual Corporate Director Aug 18, 2020
Ronald M Hofman Individual Corporate Director Aug 18, 2020
Annica Euurand Waalkes Individual Corporate Director Aug 18, 2020
Teresa Arlene Treiber Individual W-2 Managing Employee Nov 1, 2025
Matthew E Cox Individual Corporate OfficerSVP Chief Finance Officer Feb 1, 2022
Operational/Managerial Control Feb 1, 2022
Mark Wilson Individual Corporate Director Aug 18, 2020
Corewell Health Organization, Grand Rapids, MI Corporation, Non-profit, Chain home office Operational/Managerial Control Jul 1, 2013
Johannie M Torres Individual Corporate Director Aug 18, 2020
Mary Doornbos Individual Corporate Director Aug 18, 2020
John Buckley Individual Corporate Director Aug 18, 2020
Sam R Watson Individual Corporate Director Aug 18, 2020
Bill P Pink Individual Corporate Director Aug 18, 2020
Simin Beg Individual Corporate Director Aug 18, 2020
Lynnette Ferrell-Robinson Individual Corporate Director Aug 18, 2020
Tamila Marlow Individual W-2 Managing Employee Nov 1, 2025

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 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.

NPI Registry JSON

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

{
    "created_epoch": "1403222400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692662400000",
    "number": "1891109591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "722 LOCUST ST",
            "address_2": "STE 2",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493072040",
            "telephone_number": "231-592-4200",
            "fax_number": "231-527-6859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MECOSTA COUNTY MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-06-20",
        "last_updated": "2023-08-22",
        "certification_date": "2023-08-22",
        "status": "A",
        "authorized_official_last_name": "KNUTH",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "231-349-1616"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Big Rapids Hospital Obstetrics, Gynecology & Urology -",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Big Rapids Obstetrics, Gynecology and Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Spectrum Health Big Rapids Obstetrics, Gynecology and Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Big Rapids, MI

Sources for this page

Verify at the official NPI Registry.