NPIMap

Organization Active NPI

Spectrum Health Primary Care Partners

  • Vascular Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1174835102
Registry record updated Jul 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
SPECTRUM HEALTH PRIMARY CARE PARTNERS
Practice address
4085 Burton St SE
Suite 312
Grand Rapids, MI 49546-2444
Phone
(616) 284-8842
NPI assigned
Jul 7, 2010
Last updated
Jul 7, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH PRIMARY CARE PARTNERSAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 7, 2010

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

Authorized official

Name
Pauline Krywanski
Title
Cfo
Phone
(616) 486-2253

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X
Surgical Critical Care PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0102X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

4085 Burton St SE
Suite 312
Grand Rapids, MI 49546-2444

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

National Provider Directory

National Provider Directory
Tax ID family
Spectrum Health East Ca198 organizations share this tax ID, including this one
Part of
Spectrum Health East Ca

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

4085 Burton St SE
Ste 312
Grand Rapids, MI 49546
Phone (616) 284-8842

NPI Registry JSON

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

{
    "created_epoch": "1278460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278460800000",
    "number": "1174835102",
    "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": "4085 BURTON ST SE",
            "address_2": "SUITE 312",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462444",
            "telephone_number": "616-284-8842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "enumeration_date": "2010-07-07",
        "last_updated": "2010-07-07",
        "status": "A",
        "authorized_official_last_name": "KRYWANSKI",
        "authorized_official_first_name": "PAULINE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "616-486-2253"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0102X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Surgical Critical Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "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 Jul 7, 2010; 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.