Rudolph Obo Addy, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301042270 Issued in MI

Practice address

2093 Health Dr SW
Wyoming, MI 49519-9691

Phone

(616) 252-5760

NPI assigned

Jul 26, 2006

Last updated

Sep 24, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advantage Health/Saint Mary's Medical Group

  dba Trinity Health Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1376862151
  Medicare reassignment NPD
• Metropolitan Hospital

  dba Metro Health Hospital

  • Internal Medicine Physician
  • Wyoming, MI
  • NPI 1811937519

  Psychiatry

  Medicare reassignment NPD
• Michigan Sleep Institute PLLC

  • Sleep Medicine (Internal Medicine) Physician
  • Coldwater, MI
  • NPI 1609107432
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600905600000",
    "number": "1003839168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2093 HEALTH DR SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199691",
            "telephone_number": "616-252-5760"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Lake Dr SE",
            "address_2": "S-100",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495468292",
            "country_code": "US",
            "telephone_number": "616-391-3759",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ADDY",
        "first_name": "RUDOLPH",
        "middle_name": "OBO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-09-24",
        "certification_date": "2020-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301042270",
            "primary": true
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": "MI",
            "license": "4301042270",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jacob Allan Ackermann, DO
• Abigail Adams
• Amy May Adams, LLMSW
• Marieluise Otteman Adamson, LLMSW
• Add Another Positive Step
• Adia LLC
• Tonya Antionette Adkins-McKeever, MA, TLLP
• Advanced Foot and Ankle Associates, PC (Advanced Foot Ankle and Wound)
• Sydney Affholder
• Marc A Afman, DO

• Psychiatry Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.