NPIMap

Individual provider Active NPI

Laurie S Braker, MD

  • Family Medicine Physician
  • Lake Odessa, MI
National Provider Identifier
1073624573
Registry record updated Feb 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301080130 Issued in MI
Practice address
4294 Laurel Dr
Lake Odessa, MI 48849-8430
Phone
(616) 374-7660
Fax
(616) 374-0270
NPI assigned
Aug 31, 2006
Last updated
Feb 24, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301080130 MI Primary

Addresses

Primary practice location

4294 Laurel Dr
Lake Odessa, MI 48849-8430

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Other names 1

  • Laurie S Vandyke Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address lbraker1091@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050629001225 MI Practitioner - Family Practice 0648216655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Northwestern University Feinberg Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennock HospitalGroup PAC ID 4587551015, 79 clinicians

Practice addresses (Care Compare)

1005 W Green St
Hastings, MI 49058-1725

2776 S State Rd
Corewell Health Pennock Hospital
Ionia, MI 48846-8472
Phone (616) 775-7500

4294 Laurel Dr
Lake Odessa, MI 48849-8430
Phone (616) 374-7660

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301080130MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pennock Hospital Family Medicine CurrentSince Jan 1, 2014 Accepting new patients
Pennock Hospital CurrentSince Jan 1, 2014 Accepting new patients
Spectrum Health Primary Care Partners Past Accepting new patients
Brian W Swanton MD PC Past Accepting new patients
Laurie S Braker MD PLC Family Medicine PastSince Jan 1, 1990 Accepting new patients

Locations

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

1005 W Green St
Ste 300
Hastings, MI 49058
Phone (269) 948-8411

2776 S State Rd
Ionia, MI 48846
Phone (616) 267-8700

4294 Laurel Dr
Lake Odessa, MI 48849
Phone (616) 374-0099

Interoperability endpoints

  • Direct secure messaging: lbraker1091@epic00.corewelldirect.org
  • Direct secure messaging: lbraker1091@epic00.shdirect.org

Organizations & group practices 5

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 7

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": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614124800000",
    "number": "1073624573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4294 LAUREL DR",
            "city": "LAKE ODESSA",
            "state": "MI",
            "postal_code": "488498430",
            "telephone_number": "616-374-7660",
            "fax_number": "616-374-0270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAKER",
        "first_name": "LAURIE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2021-02-24",
        "certification_date": "2021-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301080130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lbraker1091@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "4294 Laurel Dr",
            "city": "Lake Odessa",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488498430",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4294 Laurel Dr",
            "city": "Lake Odessa",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488498430",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "VANDYKE",
            "middle_name": "S",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lake Odessa, MI

Sources for this page

Verify at the official NPI Registry.