Individual provider Active NPI

Tiffany Lauren Kent, MD, PHD

  • Ophthalmic Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1164686812
Registry record updated Sep 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X
License
4301092933 Issued in MI
Practice address
4070 Lake Dr SE
Suite 205
Grand Rapids, MI 49546-8294
Phone
(616) 888-2948
Fax
(616) 888-2949
NPI assigned
Jul 11, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 6, 2022

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 2012011148 MO
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X 036134962 IL
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X 4301092933 MI Primary
Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X 2012011148 MO
Ophthalmology Physician 207W00000X 4301092933 MI

Addresses

Primary practice location

4070 Lake Dr SE
Suite 205
Grand Rapids, MI 49546-8294

Mailing address

4070 Lake Dr SE
Suite 205
Grand Rapids, MI 49546-8294
Phone (616) 888-2948

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
I20160811001305 MI Practitioner - Ophthalmology 0244495042 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Wayne State University School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Oculoplastic Associates of West Michigan PLCGroup PAC ID 3870881543, 2 clinicians

Practice addresses (Care Compare)

4070 Lake Dr SE
Suite 205
Grand Rapids, MI 49546-8294
Phone (616) 888-2948

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision15
Removal or shaving of skin growth1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036134962ILMDOphthalmic Plastic and Reconstructive Surgery Physician
4301092933MIMDOphthalmic Plastic and Reconstructive Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Oculoplastic Associates of West Michigan, PLC Ophthalmic Plastic and Reconstructive Surgery CurrentSince Oct 1, 2016 Accepting new patients
Ophthalmic Plastic & Cosmetic Surgery, Inc. Past Accepting new patients

Locations

4070 Lake Dr SE
Ste 205
Grand Rapids, MI 49546
Phone (616) 888-2948

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 4

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": "1215734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662422400000",
    "number": "1164686812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 205",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-888-2948",
            "fax_number": "616-888-2949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAKE DR SE",
            "address_2": "SUITE 205",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468294",
            "telephone_number": "616-888-2948",
            "fax_number": "616-888-2949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENT",
        "first_name": "TIFFANY",
        "middle_name": "LAUREN",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-07-11",
        "last_updated": "2022-09-06",
        "certification_date": "2022-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2012011148",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "IL",
            "license": "036134962",
            "primary": false
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301092933",
            "primary": true
        },
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MO",
            "license": "2012011148",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301092933",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.