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Spectrum Health Primary Care Partners

Organization Active NPI Geriatric Medicine (Internal Medicine) Physician · Holland, MI

NPI 1023328697 · NPPES record last updated Oct 27, 2023

Key facts

NPI
1023328697
Entity type
Organization (NPI type 2)
Primary specialty
Geriatric Medicine (Internal Medicine) Physician 207RG0300X
Legal business name
SPECTRUM HEALTH PRIMARY CARE PARTNERS
Practice address
145 Columbia Ave
Holland, MI 49423-2981
Phone
(616) 820-7400
NPI assigned
Oct 18, 2010
Organization subpart
Yes
Parent organization (as reported)
SPECTRUM HEALTH PRIMARY CARE PARTNERS

Authorized official

Name
Pauline Krywanski
Title
Cfo
Phone
(616) 486-2253

Corporate family (same tax ID) 16

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

National Provider Directory

Tax ID family
Spectrum Health Partners (197 organizations share this tax ID)
Part of
Spectrum Health Partners

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X
Geriatric Medicine (Internal Medicine) Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207RG0300X Yes
Pediatric Nephrology Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2080P0210X

Addresses

Primary practice location

145 Columbia Ave
Holland, MI 49423-2981

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Other names

  • Corewell Health Medical Group West Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 27, 2023.

{
    "created_epoch": "1287360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698364800000",
    "number": "1023328697",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 COLUMBIA AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494232981",
            "telephone_number": "616-820-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "enumeration_date": "2010-10-18",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A",
        "authorized_official_last_name": "KRYWANSKI",
        "authorized_official_first_name": "PAULINE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-486-2253"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2080P0210X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Medical Group West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Holland, MI

All providers in Holland, MI · Geriatric Medicine (Internal Medicine) Physician in Michigan

Sources for this page

Verify at the official NPI Registry.