Individual provider Active NPI

Brian Drozdowski, MD

  • Internal Medicine Physician
  • Holland, MI
National Provider Identifier
1063493260
Registry record updated Sep 24, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
BD078364 Issued in MI
Practice address
437 120TH Ave
Holland, MI 49424-2119
Phone
(616) 738-0737
NPI assigned
Nov 7, 2005
Last updated
Sep 24, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X BD078364 MI Primary
Pediatrics Physician 208000000X BD078364 MI

Addresses

Primary practice location

437 120TH Ave
Holland, MI 49424-2119

Mailing address

437 120TH Ave
Holland, MI 49424-2119
Phone (616) 738-0737

Other identifiers 5

IdentifierTypeStateIssuer
P00229880OtherMIRAILROAD MEDICARE
BD078364OtherMISTATE LICENSE #
1100311602OtherMIBCBS MI PROV #
35513OtherMIHEALTH PLAN OF MI
4758203MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050701000079 MI Practitioner - Internal MedicinePractitioner - Pediatric Medicine 8123064987 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Pediatric Medicine
Education
Wayne State University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lakeshore Internal Medicine and Pediatric AssociatesGroup PAC ID 3678503331, 4 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

437 N 120TH Ave
Holland, MI 49424-2119
Phone (616) 738-0737

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
BD078364MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Internal Medicine and Pediatric Associates CurrentSince Jul 23, 2007 Accepting new patients

Locations

437 120th Ave
Holland, MI 49424
Phone (616) 738-0737

602 Michigan Ave
Holland, MI 49423
Phone (616) 394-3350

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285286400000",
    "number": "1063493260",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "437 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242119",
            "telephone_number": "616-738-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "437 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242119",
            "telephone_number": "616-738-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DROZDOWSKI",
        "first_name": "BRIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-07",
        "last_updated": "2010-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "BD078364",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "BD078364",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00229880",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE #",
            "identifier": "BD078364",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS MI PROV #",
            "identifier": "1100311602",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PLAN OF MI",
            "identifier": "35513",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4758203",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.