NPIMap

Individual provider Active NPI

Stephen Charles Peterson, DO

  • Family Medicine Physician
  • Big Rapids, MI
National Provider Identifier
1114331535
Registry record updated Jan 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101021169 Issued in MI
Practice address
14755 215TH Ave
Big Rapids, MI 49307-9224
Phone
(231) 796-3200
NPI assigned
Jun 13, 2014
Last updated
Jan 31, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2024

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 5101021169 MI Primary

Addresses

Primary practice location

14755 215TH Ave
Big Rapids, MI 49307-9224

Mailing address

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

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
I20151102000231 MI Practitioner - Family PracticePractitioner - Osteopathic Manipulative Medicine 7719297894 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecosta County Medical CenterGroup PAC ID 1951215540, 53 clinicians

Practice addresses (Care Compare)

14755 215TH Ave
Big Rapids, MI 49307-9224
Phone (231) 796-3200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101021169MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Mecosta County Medical Center CurrentSince Jan 31, 2024 Accepting new patients
Mecosta County Medical Center Family Medicine CurrentSince Jan 31, 2024 Accepting new patients
Mecosta County Medical Center Current Accepting new patients
Cherry Street Services, Inc. Family Medicine CurrentSince Jul 1, 2021 Accepting new patients
Synanon Inc CurrentSince Oct 27, 2015 Accepting new patients
Cherry Street Services, Inc CurrentSince Jul 1, 2021 Accepting new patients

Locations

14755 215th Ave
Big Rapids, MI 49307
Phone (231) 796-3200

605 Oak St
Big Rapids, MI 49307
Phone (231) 592-1079

1091 S Beacon Blvd
Grand Haven, MI 49417
Phone (616) 604-0096

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

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

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

Interoperability endpoints

  • Direct secure messaging: speterson26202@direct.trinity-health.org
  • Direct secure messaging: speterson263718@epic00.corewelldirect.org

Organizations & group practices 6

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 6

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": "1402617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706659200000",
    "number": "1114331535",
    "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": "14755 215TH AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493079224",
            "telephone_number": "231-796-3200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "STEPHEN",
        "middle_name": "CHARLES",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-13",
        "last_updated": "2024-01-31",
        "certification_date": "2024-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101021169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Big Rapids, MI

Sources for this page

Verify at the official NPI Registry.