Active NPI
Scott Carlson Schenck, MD
- Anesthesiology Physician
- Grand Rapids, MI
National Provider Identifier
1104806546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- 4301078033
- Practice address
- 3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493 - Phone
- (616) 364-4200
- Fax
- (616) 364-7347
- NPI assigned
- Jan 20, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine (Anesthesiology) Physician | 207LC0200X | 4301078033 | MI | |
| Anesthesiology Physician | 207L00000X | 4301078033 | MI | Primary |
Addresses
Primary practice location
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Mailing address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4753969 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301078033 | MI | MD | Critical Care Medicine (Anesthesiology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1542672000000",
"number": "1104806546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3333 EVERGREEN DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259493",
"telephone_number": "616-364-4200",
"fax_number": "616-364-7347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3333 EVERGREEN DR NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495259493",
"telephone_number": "616-364-4200",
"fax_number": "616-364-7347"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHENCK",
"first_name": "SCOTT",
"middle_name": "CARLSON",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2018-11-20",
"status": "A"
},
"taxonomies": [
{
"code": "207LC0200X",
"taxonomy_group": "",
"desc": "Anesthesiology, Critical Care Medicine",
"state": "MI",
"license": "4301078033",
"primary": false
},
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "MI",
"license": "4301078033",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4753969",
"state": "MI"
}
],
"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 Nov 20, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.