NPIMap

Organization Active NPI

Pathology Associates of Grand Rapids, P.C.

  • Anatomic Pathology & Clinical Pathology Physician
  • Grand Rapids, MI
National Provider Identifier
1184636821
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
PATHOLOGY ASSOCIATES OF GRAND RAPIDS, P.C.
Practice address
200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone
(616) 364-6700
Fax
(616) 364-4960
NPI assigned
Aug 12, 2006
Last updated
Apr 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Authorized official

Name
Sarat C Khandavalli, MDNPI 1295996916
Title
President
Phone
(616) 252-7249

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X Primary

Addresses

Primary practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503

Mailing address

PO Box 9186
Longview, TX 75608-9186
Phone (903) 663-4800

Other practice location 1

5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone (877) 378-4293

Other practice location 2

2122 Health Dr SW
Wyoming, MI 49519-9698
Phone (616) 252-7151

Other identifiers 1

IdentifierTypeStateIssuer
1295996916MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040122000025 MI Part B Supplier - Clinic/Group Practice 5698677573 Receives reassigned benefits from 10 practitioners
Practice locations: Wyoming, MI; Grand Rapids, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1184636821",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9186",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756089186",
            "telephone_number": "903-663-4800",
            "fax_number": "419-223-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-364-6700",
            "fax_number": "616-364-4960"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 Byron Center Ave SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495199606",
            "country_code": "US",
            "telephone_number": "877-378-4293",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2122 Health Dr SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495199698",
            "country_code": "US",
            "telephone_number": "616-252-7151",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PATHOLOGY ASSOCIATES OF GRAND RAPIDS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-12",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "KHANDAVALLI",
        "authorized_official_first_name": "SARAT",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-252-7249",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1295996916",
            "state": "MI"
        }
    ],
    "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 Apr 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.