NPIMap

Organization Active NPI

Academic Surgical Associates, PLLC

  • Surgical Oncology Physician
  • Grand Rapids, MI
National Provider Identifier
1114139045
Registry record updated Aug 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Oncology PhysicianTaxonomy code 2086X0206X
Legal business name
ACADEMIC SURGICAL ASSOCIATES, PLLC
Practice address
1000 E Paris Ave SE
Suite 150
Grand Rapids, MI 49546-3691
Phone
(616) 977-6243
Fax
(616) 977-0396
NPI assigned
May 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2007

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

Authorized official

Name
Dr. David E Scheeres, MDNPI 1225102254
Title
President
Phone
(616) 977-3990

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
Surgical Oncology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086X0206X Primary

Addresses

Primary practice location

1000 E Paris Ave SE
Suite 150
Grand Rapids, MI 49546-3691

Mailing address

1000 E Paris Ave SE
Suite 150
Grand Rapids, MI 49546-3691
Phone (616) 977-6243

Other identifiers 5

IdentifierTypeStateIssuer
4736850MedicaidMI
4745617MedicaidMI
4745635MedicaidMI
4745608MedicaidMI
700D11379OtherMIBCBS GROUP NUMBER

National Provider Directory

National Provider Directory

Locations

3831 Hughes Ave
Ste 115
Culver City, CA 90232

4515 Castle Rd
La Canada Flt, CA 91011
Phone (626) 321-6130

1000 East Paris Ave SE
Ste 150
Grand Rapids, MI 49546
Phone (616) 977-6243

Practitioners & affiliated clinicians

Practitioners 8

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": "1178236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186358400000",
    "number": "1114139045",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE",
            "address_2": "SUITE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463691",
            "telephone_number": "616-977-6243",
            "fax_number": "616-977-0396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E PARIS AVE SE",
            "address_2": "SUITE 150",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463691",
            "telephone_number": "616-977-6243",
            "fax_number": "616-977-0396"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC SURGICAL ASSOCIATES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-04",
        "last_updated": "2007-08-06",
        "status": "A",
        "authorized_official_last_name": "SCHEERES",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-977-3990",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086X0206X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4736850",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4745617",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4745635",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4745608",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "700D11379",
            "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 Aug 6, 2007; 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.