NPIMap

Organization Active NPI

Thomas W Pfennig DO

Doing business as Grand Rapids Ear Nose and Throat PC

  • Otolaryngology Physician
  • Wyoming, MI
National Provider Identifier
1063639870
Registry record updated Jul 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
THOMAS W PFENNIG DO
Doing business as
Grand Rapids Ear Nose and Throat PC
Practice address
1555 - 44TH Street SW
Wyoming, MI 49509
Phone
(616) 249-8000
NPI assigned
Apr 20, 2007
Last updated
Jul 9, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2015

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

Authorized official

Name
Dr. Thomas W Pfennig, DONPI 1508821901
Title
Owner
Phone
(616) 249-8000

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
Otolaryngology Physician 207Y00000X Primary

Addresses

Primary practice location

1555 - 44TH Street SW
Wyoming, MI 49509

Mailing address

1555 44TH St SW
Wyoming, MI 49509-4395
Phone (616) 249-8000

Other names 1

  • Grand Rapids Ear Nose and Throat PC Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081003000541 MI Part B Supplier - Clinic/Group Practice 2466520473 Receives reassigned benefits from 16 practitioners
Practice locations: Wyoming, MI

National Provider Directory

National Provider Directory

Locations

1555 44th St SW
Wyoming, MI 49509
Phone (616) 249-8000

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1436400000000",
    "number": "1063639870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 44TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495094395",
            "telephone_number": "616-249-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 - 44TH STREET SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "49509",
            "telephone_number": "616-249-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOMAS W PFENNIG DO",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-20",
        "last_updated": "2015-07-09",
        "status": "A",
        "authorized_official_last_name": "PFENNIG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-249-8000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Rapids Ear Nose and Throat PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2015; 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.