Individual provider Active NPI

Kevin L Vanallen, MD

  • General Practice Physician
  • Grand Haven, MI
National Provider Identifier
1154373249
Registry record updated Feb 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
4301053221 Issued in MI
Practice address
15100 Whittaker Way
Grand Haven, MI 49417-8696
Phone
(616) 935-6200
NPI assigned
May 17, 2006
Last updated
Feb 16, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 4301053221 MI Primary

Addresses

Primary practice location

15100 Whittaker Way
Grand Haven, MI 49417-8696

Mailing address

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

Other identifiers 7

IdentifierTypeStateIssuer
0804103371OtherMIBCBS
4770010MedicaidMI
1598712390OtherMIGROUP NPI
4770001MedicaidMI
4773952MedicaidMI
4770020MedicaidMI
4773881MedicaidMI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address Kevin.VanAllen@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041129000266 MI Practitioner - Family Practice 6901861269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Loma Linda University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Holland Community HospitalGroup PAC ID 0446157291, 174 clinicians

Practice addresses (Care Compare)

3232 N Wellness Dr
Holland Hospital Urgent Care
Holland, MI 49424-8027
Phone (616) 494-4250

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301053221MIMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Holland Community Hospital Current Accepting new patients
Holland Community Hospital CurrentSince Nov 1, 2020 Accepting new patients
Holland Community Hospital CurrentSince Nov 1, 2020 Accepting new patients
Spectrum Health Urgent Care Past Accepting new patients
Holland Community Hospital Past Accepting new patients

Locations

15100 Whittaker Way
Grand Haven, MI 49417
Phone (616) 935-6200

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

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

3232 N Wellness Dr
Holland, MI 49424
Phone (616) 494-4250

602 Michigan Ave
Holland, MI 49423
Phone (616) 394-3350

Interoperability endpoints

  • Direct secure messaging: kevin.vanallen@epic00.shdirect.org

Organizations & group practices 5

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 1

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": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613433600000",
    "number": "1154373249",
    "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": "15100 WHITTAKER WAY",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494178696",
            "telephone_number": "616-935-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANALLEN",
        "first_name": "KEVIN",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-17",
        "last_updated": "2021-02-16",
        "certification_date": "2021-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301053221",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0804103371",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4770010",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1598712390",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4770001",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4773952",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4770020",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4773881",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Kevin.VanAllen@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "15100 Whittaker Way",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494178696",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "15100 Whittaker Way",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494178696",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

Verify at the official NPI Registry.