Individual provider Active NPI

Andrea Mantel

  • Anesthesiologist Assistant
  • Grand Rapids, MI
National Provider Identifier
1205454998
Registry record updated Jul 8, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
Practice address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone
(616) 284-3132
NPI assigned
Jul 8, 2020
Last updated
Jul 8, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X NU Primary

Addresses

Primary practice location

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493

Mailing address

603 Parkwood St NE
Grand Rapids, MI 49503-3413

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200917000613 MI Practitioner - Anesthesiology Assistant 7517385925 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Anesthesia PCGroup PAC ID 1355243551, 69 clinicians
Anesthesia Medical Consultants, PCGroup PAC ID 3678751658, 87 clinicians

Practice addresses (Care Compare)

3333 Evergeen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

555 Midtowne St NE
200 Metro Health Oam Surgery Center
Grand Rapids, MI 49503-5731
Phone (616) 364-4200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Medical Consultants, PC CurrentSince Sep 1, 2020 Accepting new patients

Locations

3333 Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 284-3132

4055 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 252-4410

555 Midtowne St NE
Ste 200
Grand Rapids, MI 49503
Phone (616) 252-4500

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, 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": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1205454998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "603 PARKWOOD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495033413"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-284-3132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANTEL",
        "first_name": "ANDREA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "NU",
            "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 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.