NPIMap

Organization Active NPI

Primary Care Surgical PLLC

  • Family Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1134440605
Registry record updated Jan 17, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
PRIMARY CARE SURGICAL PLLC
Practice address
2290 Kamp Valley CT NE
Grand Rapids, MI 49525-9758
Phone
(616) 685-1808
NPI assigned
Jun 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2011

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

Authorized official

Name
Fred Reyelts
Title
MD
Phone
(616) 685-1808

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2290 Kamp Valley CT NE
Grand Rapids, MI 49525-9758

Mailing address

2290 Kamp Valley CT NE
Grand Rapids, MI 49525-9758

National Provider Directory

National Provider Directory

Locations

245 Cherry St SE
Ste 102
Grand Rapids, MI 49503
Phone (616) 201-3909

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1276819200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295222400000",
    "number": "1134440605",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2290 KAMP VALLEY CT NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259758"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2290 KAMP VALLEY CT NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259758",
            "telephone_number": "616-685-1808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY CARE SURGICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-18",
        "last_updated": "2011-01-17",
        "status": "A",
        "authorized_official_last_name": "REYELTS",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "616-685-1808"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Jan 17, 2011; 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.