Great Lakes Pediatric Associates

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

4301049233 Issued in MI

Legal business name

GREAT LAKES PEDIATRIC ASSOCIATES

Practice address

3400 Pinetree Rd
Ste 102
Lansing, MI 48911-4286

Phone

(517) 887-3000

NPI assigned

Oct 1, 2009

Organization subpart

No

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

Authorized official

Name

Ms. Beth Ileen Charles

Title

Practice Manager

Phone

(517) 887-3000

Specialties & licenses 4

Addresses

Other identifiers 7

Locations

Interoperability endpoints

• FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/57729

Practitioners 2

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

• Bradley R. Hoopingarner, M.D.

  • Pediatrics Physician
  • St Johns, MI
  • NPI 1063401594
  NPD (past)
• Leslie K Reynolds, MD

  • Pediatrics Physician
  • Lansing, MI
  • NPI 1144338443
  NPD (past)

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

{
    "created_epoch": "1254355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254355200000",
    "number": "1023342474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 PINETREE RD",
            "address_2": "STE 102",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489114286",
            "telephone_number": "517-887-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 PINETREE RD",
            "address_2": "STE 102",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489114286",
            "telephone_number": "517-887-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PEDIATRIC ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-01",
        "last_updated": "2009-10-01",
        "status": "A",
        "authorized_official_last_name": "CHARLES",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "ILEEN",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "517-887-3000",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301049233",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301063626",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301078945",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301086445",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3069367",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3080275",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4366885",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144338443",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1144338450",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1730297045",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1831309921",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melodee Anne Graybill, LMSW
• Katherine Grayden, MD
• Allie Michelle Grden, PT, DPT
• Great Lakes Family Dental Group Lansing PC
• Great Lakes Lithotripsy, LLC
• Greater Lansing Chiropractic
• Greater Lansing Chiropractic Clinics Inc
• Greater Lansing Orthotic Clinic Inc.
• Greater Lansing Surgeons, P.C.
• Kristina Greathouse, PT, DPT, MTC

• Pediatrics Physician in Lansing, MI
• Providers in Lansing, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.