NPIMap

Organization Active NPI

Spectrum Health Primary Care Partners

Doing business as Corewell Health Medical Group West

  • Sleep Medicine (Psychiatry & Neurology) Physician
  • Lakeview, MI
National Provider Identifier
1033416474
Registry record updated Oct 31, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Psychiatry & Neurology) PhysicianTaxonomy code 2084S0012X
Legal business name
SPECTRUM HEALTH PRIMARY CARE PARTNERS
Doing business as
Corewell Health Medical Group West
Practice address
418 Washington St
Lakeview, MI 48850-9806
Phone
(989) 352-8452
NPI assigned
Feb 22, 2011
Last updated
Oct 31, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH PRIMARY CARE PARTNERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 31, 2023

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

Authorized official

Name
Polly Krywanski
Title
SVP, Finance
Phone
(616) 486-2253

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Endocrinology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0205X
Sleep Medicine (Psychiatry & Neurology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2084S0012X Primary

Addresses

Primary practice location

418 Washington St
Lakeview, MI 48850-9806

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Phone (616) 486-6795

Other names 1

  • Corewell Health Medical Group West Doing business as

National Provider Directory

National Provider Directory
Tax ID family
BMMC Ferguson Clinic199 organizations share this tax ID, including this one
Part of
BMMC Ferguson Clinic

Organizations with this tax ID in the same state 18

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698710400000",
    "number": "1033416474",
    "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",
            "telephone_number": "616-486-6795"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418 WASHINGTON ST",
            "city": "LAKEVIEW",
            "state": "MI",
            "postal_code": "488509806",
            "telephone_number": "989-352-8452"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "enumeration_date": "2011-02-22",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A",
        "authorized_official_last_name": "KRYWANSKI",
        "authorized_official_first_name": "POLLY",
        "authorized_official_title_or_position": "SVP, FINANCE",
        "authorized_official_telephone_number": "616-486-2253"
    },
    "taxonomies": [
        {
            "code": "2080P0205X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Endocrinology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084S0012X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Medical Group West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lakeview, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2023; 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.