Active NPI
Jeffrey M Ricketts, DO
- Anesthesiology Physician
- Grand Rapids, MI
National Provider Identifier
1033172184
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 5101008399
- Practice address
- 3333 Evergreen Dr NE
Grand Rapids, MI 49525-9756 - Phone
- (616) 364-4200
- Fax
- (616) 364-7347
- NPI assigned
- Apr 10, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | 5101008399 | MI | Primary |
Addresses
Primary practice location
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9756
Mailing address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9756
Phone (616) 364-4200
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3318293 | Medicaid | MI | |
| 050D110480 | Other | MI | BCBS GROUP BILL PIN |
| 5410038 | Other | MI | BCBS PIN |
| JR008399 | Other | MI | BCBS LICENSE NUMBER |
| 050054284 | Other | MI | RAILROAD MEDICARE |
| CE1952 | Other | MI | RAILROAD GROUP NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101008399 | MI | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1404345600000",
"number": "1033172184",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 EVERGREEN DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259756",
"telephone_number": "616-364-4200",
"fax_number": "616-364-7347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 EVERGREEN DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259756",
"telephone_number": "616-364-4200",
"fax_number": "616-364-7347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RICKETTS",
"first_name": "JEFFREY",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-10",
"last_updated": "2014-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MI",
"license": "5101008399",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3318293",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS GROUP BILL PIN",
"identifier": "050D110480",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "5410038",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS LICENSE NUMBER",
"identifier": "JR008399",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "050054284",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD GROUP NUMBER",
"identifier": "CE1952",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.