NPIMap

Organization Active NPI

Bronson Lakeview Hospital

  • Critical Access Hospital
  • Paw Paw, MI
National Provider Identifier
1962508259
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
BRONSON LAKEVIEW HOSPITAL
Practice address
408 Hazen St
Paw Paw, MI 49079-1019
Phone
(269) 657-3141
Fax
(269) 657-1474
NPI assigned
Sep 15, 2006
Last updated
Dec 27, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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

Authorized official

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X
Critical Access Hospital 282NC0060X Primary

Addresses

Primary practice location

408 Hazen St
Paw Paw, MI 49079-1019

Mailing address

601 John St
Box 42
Kalamazoo, MI 49007-5341
Phone (269) 341-7806

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080516000276 MI Part A Provider - Critical Access Hospital 9032008495 Receives reassigned benefits from 43 practitioners
Practice locations: Mattawan, MI; Paw Paw, MI
O20220526001376 MI Part A Provider - Critical Access Hospital 9032008495 Practice locations: Paw Paw, MI

NPI to CCN mapping 3

The Medicare certification numbers (CCNs) connected to NPI 1962508259. Details of each certification follow.

Hospital certification: CCN 231332

Legal name
BRONSON LAKEVIEW HOSPITAL
Doing business as
BRONSON LAKEVIEW HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Dec 1, 2005
Last certification
Oct 13, 2016
Beds
25
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
408 Hazen St
Paw Paw, MI 49079-1019

Hospital certification: CCN 23Z332

Legal name
BRONSON LAKEVIEW HOSPITAL
Organization structure
CorporationNon-profit
Incorporated
Jan 1, 1990 in MI
Enrollment address
408 Hazen St
Paw Paw, MI 49079-1019
Hospital Swing-Bed Unit

Hospital certification: CCN 230172

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
LAKEVIEW COMMUNITY HOSPITAL
Certification status
Terminated Other: provider status change, Dec 1, 2005
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Apr 12, 1996
Beds
48 (33 certified)
Ownership / control type
Hospital district or authority
Facility address
408 Hazen St
Paw Paw, MI 49079

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).

Care Compare: Hospital

Medicare Care Compare
Listed as
Bronson Lakeview HospitalCCN 231332 · All quality measures
Overall star rating
5 of 5
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

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
23D0377848Bronson Lakeview Hospital408 Hazen Street, Paw Paw, MI 49079AccreditationJan 2, 2027
23D2223069Bronson Lakeview Hospital Ancillary Testing408 Hazen Street, Paw Paw, MI 49079Certificate of waiverMay 3, 2027

National Provider Directory

National Provider Directory

Locations

404 Hazen St
Ste 101
Paw Paw, MI 49079
Phone (269) 657-2550

Ownership & related parties

All disclosed owners & managing parties 35

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 May 13, 2020
Penny a Miller Individual W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
Mike Way Individual Corporate OfficerSVP Jan 1, 1986
Rebecca East Individual Corporate OfficerSVP, Cfo Feb 1, 2015
W-2 Managing EmployeeSVP, Cfo Feb 1, 2015
Corporate OfficerSVP, Cfo Feb 1, 2015
W-2 Managing EmployeeSVP, Cfo Feb 1, 2015
Lajune Montgomery-Tabron Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2011
Denise Neely Individual Corporate OfficerSVP, Coo Jan 1, 2005
Corporate OfficerSVP, Coo Jan 1, 2005
Michael F Odar Individual Corporate DirectorDirector Jul 1, 2016
Corporate Director Jul 1, 2016
Steven J Lins Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2011
Barbara L James Individual Corporate Director Jan 1, 2008
Emilee Nason Individual W-2 Managing Employee Apr 24, 2020
Susan Reinoehl Individual Corporate OfficerSVP, Cso Jan 1, 1995
Corporate OfficerSVP, Cso Jan 1, 1995
Ashley Rhoderick Individual W-2 Managing Employee Apr 24, 2020
Mark B Atkinson Individual Corporate DirectorDirector Sep 28, 2012
James L Liggins Individual Corporate DirectorDirector Jan 1, 2016
Cheryl Johnson Individual Corporate OfficerSVP, Cpo Jan 1, 2021
Corporate OfficerSVP, Cpo Jan 1, 2021
Leigh Ann Colegrove Individual W-2 Managing EmployeeSystem Credentialing Coordinator Oct 11, 2021
William D Johnston Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2011
Jorge Gonzalez Individual Corporate DirectorDirector Jan 1, 2018
Richard J Allen Individual Corporate DirectorDirector Jan 1, 2017
Bronson Health Care Group Inc Organization, Kalamazoo, MI Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2008 100%
Operational/Managerial Control Jan 1, 2008
Jamie N Squires Individual W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
Scott Larson Individual Corporate OfficerSVP Cmo Jun 1, 2014
W-2 Managing EmployeeSVP Cmo Jun 1, 2014
Corporate OfficerSVP Cmo Jun 1, 2014
W-2 Managing EmployeeSVP Cmo Jun 1, 2014
Sridhar Chalasani Individual Corporate OfficerSystem Chief of Staff Jan 1, 2020
Corporate OfficerSystem Chief of Staff Jan 1, 2020
Mary Fink Individual Corporate DirectorDirector Jan 1, 2017
Scott C Gibson Individual Corporate Director Jun 1, 2008
Mahesh C Karamchandani Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate Director Jul 1, 2011
Scott B Davidson Individual Corporate DirectorDirector Sep 22, 2016
Randall W. Eberts Individual Corporate Director Jan 1, 2008
Marisa Eason Individual W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
W-2 Managing EmployeeProvider Enrollment Jan 1, 2022
Brenda L Hunt Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate Director Jul 1, 2011
Donald R. Parfet Individual Corporate Director Jan 1, 2008
Kirk Richardson Individual Corporate OfficerVP Chief Operating Officer Chief Jun 1, 2014
W-2 Managing EmployeeVP Chief Operating Officer Chief Jun 1, 2014
James B Falahee Individual Corporate OfficerSVP Legal and Legislative Affair Jun 1, 2014
W-2 Managing EmployeeSVP Legal & Legislative Affairs Jun 1, 2014
W-2 Managing EmployeeSVP Legal & Legislative Affairs Jun 1, 2014
Neil Nyberg Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2011
Nelson Karre Individual Corporate DirectorBoard Member Jul 1, 2011
Corporate DirectorBoard Member Jul 1, 2011

Owners & managing parties with NPI records 7

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.

Subparts reporting this organization as parent 4

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 49

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 49

Affiliated clinicians 538

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 538

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703635200000",
    "number": "1962508259",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "BOX 42",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-7806",
            "fax_number": "269-341-8743"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 HAZEN ST",
            "city": "PAW PAW",
            "state": "MI",
            "postal_code": "490791019",
            "telephone_number": "269-657-3141",
            "fax_number": "269-657-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRONSON LAKEVIEW HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A",
        "authorized_official_last_name": "EAST",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SVP, CFO",
        "authorized_official_telephone_number": "269-341-6000"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "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 Direct address",
            "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": []
}

Other providers in Paw Paw, MI

Sources for this page

Verify at the official NPI Registry.