NPIMap

Organization Active NPI

OB/GYN Associates of Holland, PC

  • Obstetrics & Gynecology Physician
  • Holland, MI
National Provider Identifier
1003988460
Registry record updated Feb 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
OB/GYN ASSOCIATES OF HOLLAND, PC
Practice address
664 Michigan Ave
Holland, MI 49423-4944
Phone
(616) 392-5973
Fax
(616) 392-1646
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2021

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

Authorized official

Name
Dawn Marie Dauchy
Title
Administrator
Phone
(616) 795-4440

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207V00000X Primary

Addresses

Primary practice location

664 Michigan Ave
Holland, MI 49423-4944

Mailing address

664 Michigan Ave
Holland, MI 49423-4944
Phone (616) 392-5973

Other identifiers 6

IdentifierTypeStateIssuer
4826591MedicaidMI
2929007MedicaidMI
4092726MedicaidMI
3144434MedicaidMI
2715083MedicaidMI
4506752MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060202000678 MI Part B Supplier - Clinic/Group Practice 7214941244 Receives reassigned benefits from 14 practitioners
Practice locations: Holland, MI

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
23D0673735OB GYN Associates of Holland PC664 Michigan Avenue, Holland, MI 49423Provider-performed microscopyAug 31, 2026

National Provider Directory

National Provider Directory

Locations

1475 Robbins Rd
Ste 100
Grand Haven, MI 49417
Phone (616) 392-5973

3290 N Wellness Dr
Ste 120
Holland, MI 49424
Phone (616) 392-5973

664 Michigan Ave
Holland, MI 49423
Phone (616) 392-5973

749 Phillips St
South Haven, MI 49090
Phone (616) 392-5973

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612224000000",
    "number": "1003988460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "664 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234944",
            "telephone_number": "616-392-5973",
            "fax_number": "616-392-1646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "664 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234944",
            "telephone_number": "616-392-5973",
            "fax_number": "616-392-1646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OB/GYN ASSOCIATES OF HOLLAND, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A",
        "authorized_official_last_name": "DAUCHY",
        "authorized_official_first_name": "DAWN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "616-795-4440"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4826591",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2929007",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4092726",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3144434",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2715083",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4506752",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.