Individual provider Active NPI

Andrea Landon, DO

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1104238484
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101021139 Issued in MI
Practice address
2144 E Paris Ave SE # 200
Grand Rapids, MI 49546-6111
Phone
(616) 685-2100
Fax
(616) 685-2111
NPI assigned
May 21, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 5101021139 MI Primary

Addresses

Primary practice location

2144 E Paris Ave SE # 200
Grand Rapids, MI 49546-6111

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008

Other practice location 1

1000 Oakland Dr
Kalamazoo, MI 49008-1282
Phone (269) 337-4400

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address andrea.landon@mercyhealth.com Direct

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
I20170908001812 MI Practitioner - Internal Medicine 7618193855 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 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)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

2144 E Paris Ave SE
Suite 200
Grand Rapids, MI 49546-6126
Phone (616) 685-2100

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

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

Hospital & facility affiliations

  • Mary Free Bed at Home, LLC Home health agency, Grand Rapids, MI, CCN 237203
  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Sep 25, 2017 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Sep 25, 2017 Accepting new patients
Advantage Health Saint Mary'S Medical Group Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

2144 East Paris Ave SE
Ste 200
Grand Rapids, MI 49546
Phone (616) 685-2100

Interoperability endpoints

  • Direct secure messaging: alandon32576@direct.trinity-health.org

Organizations & group practices 4

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

Hospital & facility affiliations 4

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": "1400630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1104238484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2144 E PARIS AVE SE # 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466111",
            "telephone_number": "616-685-2100",
            "fax_number": "616-685-2111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 Oakland Dr",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490081282",
            "country_code": "US",
            "telephone_number": "269-337-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANDON",
        "first_name": "ANDREA",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-05-21",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101021139",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "andrea.landon@mercyhealth.com",
            "affiliation": "N",
            "endpointDescription": "MHPP EPIM",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "2144 E Paris Ave SE # 200",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495466111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.