Organization Active NPI

Western Michigan Pathology Associates, LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Holland, MI
National Provider Identifier
1053394080
Registry record updated May 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
WESTERN MICHIGAN PATHOLOGY ASSOCIATES, LLC
Practice address
602 Michigan Ave
Holland, MI 49423-4918
Phone
(616) 392-5141
Fax
(419) 866-5453
NPI assigned
Nov 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 21, 2026

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

Authorized official

Name
Matthew David CarrNPI 1710199021
Title
Authorized Official
Phone
(800) 288-8325

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

602 Michigan Ave
Holland, MI 49423-4918

Mailing address

5700 Southwyck Blvd
Toledo, OH 43614-1509
Phone (800) 288-8325

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20090121000481 MI Part B Supplier - Clinic/Group Practice 4880758705 Receives reassigned benefits from 3 practitioners
Practice locations: Holland, MI
O20180425001788 MI Part B Supplier - Clinic/Group Practice 7911261011 Receives reassigned benefits from 2 practitioners
Practice locations: Holland, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

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

NPI Registry JSON

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1779321600000",
    "number": "1053394080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5700 SOUTHWYCK BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436141509",
            "telephone_number": "800-288-8325",
            "fax_number": "419-866-5453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234918",
            "telephone_number": "616-392-5141",
            "fax_number": "419-866-5453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTERN MICHIGAN PATHOLOGY ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-23",
        "last_updated": "2026-05-21",
        "certification_date": "2026-05-21",
        "status": "A",
        "authorized_official_last_name": "CARR",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "800-288-8325"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 May 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.