NPIMap

Organization Active NPI

Intercare Community Health Network

Doing business as InterCare Riverwood Center

  • Federally Qualified Health Center (FQHC)
  • Benton Harbor, MI
National Provider Identifier
1902235328
Registry record updated Apr 24, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
INTERCARE COMMUNITY HEALTH NETWORK
Doing business as
InterCare Riverwood Center
Practice address
1485 M 139
Benton Harbor, MI 49022-5711
Phone
(269) 926-2595
Fax
(269) 757-7630
NPI assigned
Nov 6, 2013
Last updated
Apr 24, 2014By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2014

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

Authorized official

Name
Velma Hendershott
Title
Ceo/President
Phone
(269) 427-7937

Specialties & licenses 1

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

Addresses

Primary practice location

1485 M 139
Benton Harbor, MI 49022-5711

Mailing address

50 Industrial Park Drive
Bangor, MI 49013-1246
Phone (269) 427-7937

Other names 1

  • InterCare Riverwood Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040223000150 MI Part B Supplier - Clinic/Group Practice 9537061254 Receives reassigned benefits from 109 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Benton Harbor, MI; Pullman, MI; Holland, MI; Bangor, MI; Eau Claire, MI

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

Locations

50 Industrial Park Rd
Bangor, MI 49013
Phone (269) 427-7937

Practitioners & affiliated clinicians

Practitioners 13

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 13

NPI Registry JSON

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

{
    "created_epoch": "1383696000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398297600000",
    "number": "1902235328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 INDUSTRIAL PARK DRIVE",
            "city": "BANGOR",
            "state": "MI",
            "postal_code": "490131246",
            "telephone_number": "269-427-7937",
            "fax_number": "269-427-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1485 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490225711",
            "telephone_number": "269-926-2595",
            "fax_number": "269-757-7630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERCARE COMMUNITY HEALTH NETWORK",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-06",
        "last_updated": "2014-04-24",
        "status": "A",
        "authorized_official_last_name": "HENDERSHOTT",
        "authorized_official_first_name": "VELMA",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-427-7937"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "InterCare Riverwood Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Benton Harbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.