NPIMap

Organization Active NPI

Mary Free Bed Rehabilitation Hospital

Doing business as Mary Free Bed Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
National Provider Identifier
1053641589
Registry record updated Apr 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
Legal business name
MARY FREE BED REHABILITATION HOSPITAL
Doing business as
Mary Free Bed Medical Group
Practice address
235 Wealthy St SE
Ste 100
Grand Rapids, MI 49503-5247
Phone
(616) 840-8000
Fax
(616) 840-9640
NPI assigned
Jan 6, 2010
Last updated
Apr 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY FREE BED HOSPITAL AND REHABILITATION CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 15, 2021

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

Authorized official

Name
Ryan Podvin
Title
Cfo
Phone
(616) 840-8317

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208100000X MI Primary

Addresses

Primary practice location

235 Wealthy St SE
Ste 100
Grand Rapids, MI 49503-5247

Mailing address

235 Wealthy St SE
Ste 100
Grand Rapids, MI 49503-5247
Phone (616) 840-8000

Other names 1

  • Mary Free Bed Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000604 MI Part B Supplier - Clinic/Group Practice 4587576541 Receives reassigned benefits from 215 practitioners
3 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Traverse City, MI; Wyoming, MI; Saginaw, MI; Norton Shores, MI; Kalamazoo, MI; Holland, MI; Grand Rapids, MI; Elk Rapids, MI

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Mary Free Bed Hospital and Rehabilitation

Member organizations 6

Organizations listed as members of this organization in the National Provider Directory.

Locations

128 Ames St
Elk Rapids, MI 49629
Phone (231) 264-6682

235 Wealthy St SE
Ste 101
Grand Rapids, MI 49503

350 Lafayette Ave SE
Ste 308
Grand Rapids, MI 49503
Phone (616) 451-9925

1362 S Pointe Rdg
Holland, MI 49423
Phone (616) 458-1187

335 N 120th Ave
Holland, MI 49424
Phone (616) 392-5222

7125 Stadium Dr
Kalamazoo, MI 49009
Phone (269) 492-6575

1215 E Michigan Ave
Fl 6
Lansing, MI 48912
Phone (517) 364-3375

6425 Harvey St
Norton Shores, MI 49444
Phone (231) 737-3469

39475 Lewis Dr
Ste 290
Novi, MI 48377
Phone (248) 206-4457

3700 Silver Lake Rd
Traverse City, MI 49684
Phone (231) 421-1599

4025 Chums Village Dr
Ste E
Traverse City, MI 49685

5722 Metro Way SW
Wyoming, MI 49519
Phone (616) 252-6065

Practitioners & affiliated clinicians

Practitioners 224

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 224

NPI Registry JSON

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

{
    "created_epoch": "1262736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618444800000",
    "number": "1053641589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "address_2": "STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000",
            "fax_number": "616-840-9640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 WEALTHY ST SE",
            "address_2": "STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035247",
            "telephone_number": "616-840-8000",
            "fax_number": "616-840-9640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY FREE BED REHABILITATION HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY FREE BED HOSPITAL AND REHABILITATION CENTER",
        "enumeration_date": "2010-01-06",
        "last_updated": "2021-04-15",
        "certification_date": "2021-04-15",
        "status": "A",
        "authorized_official_last_name": "PODVIN",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-840-8317"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Free Bed Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mary Free Bed Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Apr 15, 2021; 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.