Individual provider Active NPI

Susan Grace Passavant, NP

  • Acute Care Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1124406582
Registry record updated Jun 26, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Acute Care Nurse PractitionerTaxonomy code 363LA2100X
License
4704280442 Issued in MI
Practice address
221 Michigan St NE Ste 400
Grand Rapids, MI 49503-2543
Phone
(616) 486-9600
NPI assigned
May 18, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X 4704280442 MI Primary

Addresses

Primary practice location

221 Michigan St NE Ste 400
Grand Rapids, MI 49503-2543

Mailing address

100 Michigan St NE
MC 845
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: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150626001192 MI Practitioner - Nurse Practitioner 7618289026 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560

100 Michigan St NE RM
280 Corewell Health Medical Group West
Grand Rapids, MI 49503-2560
Phone (616) 267-0115

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Jun 18, 2015 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jun 18, 2015 Accepting new patients

Locations

221 Michigan St NE
Ste 400
Grand Rapids, MI 49503
Phone (616) 486-9600

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

221 Michigan St NE
Ste 406
Grand Rapids, MI 49503
Phone (616) 391-5701

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

Interoperability endpoints

  • Direct secure messaging: spassavant113231@epic00.corewelldirect.org

Organizations & group practices 2

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 2

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": "1431907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561507200000",
    "number": "1124406582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032543",
            "telephone_number": "616-486-9600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASSAVANT",
        "first_name": "SUSAN",
        "middle_name": "GRACE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-05-18",
        "last_updated": "2019-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "MI",
            "license": "4704280442",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.