NPIMap

Organization Active NPI

MMPC Weight Management

  • Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1083637003
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
MMPC WEIGHT MANAGEMENT
Practice address
4100 Lake Dr SE
S-B01
Grand Rapids, MI 49546-8292
Phone
(616) 974-4400
NPI assigned
Jul 25, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Daniel Grevengoed
Title
Cpa
Phone
(616) 974-4431

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

4100 Lake Dr SE
S-B01
Grand Rapids, MI 49546-8292

Mailing address

4100 Lake Dr SE
S-300
Grand Rapids, MI 49546-8292

National Provider Directory

National Provider Directory
Tax ID family
Michigan Med Spec PC70 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 15

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 15

Locations

4100 Lake Dr SE
#1
Grand Rapids, MI 49546
Phone (616) 974-4400

4100 Lake Dr SE
#S300
Grand Rapids, MI 49546

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083637003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 LAKE DR SE",
            "address_2": "S-300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468292"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE DR SE",
            "address_2": "S-B01",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468292",
            "telephone_number": "616-974-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MMPC WEIGHT MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GREVENGOED",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "CPA",
        "authorized_official_telephone_number": "616-974-4431"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.