NPIMap

Organization Active NPI

Catherines Health Center

  • Federally Qualified Health Center (FQHC)
  • Kentwood, MI
National Provider Identifier
1992437826
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
CATHERINES HEALTH CENTER
Practice address
100 60TH St SE
Kentwood, MI 49548-6804
Phone
(616) 336-8800
NPI assigned
Jun 29, 2022
Organization subpart
Yes
Parent organization
CATHERINES HEALTH CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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 Primary

Addresses

Primary practice location

100 60TH St SE
Kentwood, MI 49548-6804

Mailing address

1211 Lafayette Ave NE
Grand Rapids, MI 49505-5092

Other names 1

  • Catherines Health Center at Townline Elementary Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221026002181 MI Part A Provider - Federally Qualified Health Center (FQHC) 2860615838 Practice locations: Grand Rapids, MI

Federally qualified health center certification: CCN 231185

Legal name
CATHERINE'S HEALTH CENTER
Doing business as
CATHERINE'S HEALTH CENTER TOWNLINE
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Oct 25, 2022
Last certification
Oct 25, 2022
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
100 60TH St SE
RM E3 Ste a
Grand Rapids, MI 49548-6804

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

National Provider Directory

National Provider Directory
Tax ID family
Catherines Health Center13 organizations share this tax ID, including this one
Part of
Catherines Health Center

Other organizations with this tax ID 12

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

Locations

100 60th St SE
Kentwood, MI 49548
Phone (616) 538-4120

Ownership & related parties

All disclosed owners & managing parties 16

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 Jan 1, 2022
Dustin Maynes Individual Corporate Director Jan 1, 2022
Adrienne Goodstal Individual Corporate DirectorVice President Jan 1, 2023
Allison Shook Individual Corporate Director Jan 1, 2022
Cole Sweda Individual Corporate Officer Jan 1, 2024
Jade Kennedy Individual Corporate Officer Jan 1, 2026
Catherine Kelly Individual Corporate Officer Jan 1, 2023
Zandra Vazquez Individual Corporate Officer Jan 1, 2026
Megan Erskine Individual Corporate OfficerCeo Apr 12, 2022 100%
W-2 Managing EmployeeCeo Jun 9, 2022
Operational/Managerial ControlCeo Apr 12, 2022 100%
Mark a Contreras Individual Corporate Director Jan 1, 2022
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 Officer 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.

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

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": "1656460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1656460800000",
    "number": "1992437826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 60TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495486804",
            "telephone_number": "616-336-8800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CATHERINES HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CATHERINES HEALTH CENTER",
        "enumeration_date": "2022-06-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-21",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Catherines Health Center at Townline Elementary",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kentwood, MI

Sources for this page

Verify at the official NPI Registry.