Active NPI
Wayne Smith, DO
- Occupational Medicine Physician
- Grand Rapids, MI
National Provider Identifier
1205842101
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Medicine Physician
- License
- 5101011102
- Practice address
- 3210 Eagle Run Dr NE Ste 100
Grand Rapids, MI 49525-7051 - Phone
- (616) 279-3725
- NPI assigned
- Jul 31, 2006
- Last updated
- Nov 21, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101011102 | MI | |
| Occupational Medicine Physician | 2083X0100X | 5101011102 | MI | Primary |
Addresses
Primary practice location
3210 Eagle Run Dr NE Ste 100
Grand Rapids, MI 49525-7051
Mailing address
PO Box 1847
Muskegon, MI 49443-1847
Phone (231) 672-4900
Other practice location 1
1140 Monroe Ave NW
Suite 150
Grand Rapids, MI 49503-1055
Phone (616) 459-6331
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4615238 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Urgent Care | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1574294400000",
"number": "1205842101",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1847",
"city": "MUSKEGON",
"state": "MI",
"postal_code": "494431847",
"telephone_number": "231-672-4900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3210 EAGLE RUN DR NE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495257051",
"telephone_number": "616-279-3725"
}
],
"practiceLocations": [
{
"address_1": "1140 Monroe Ave NW",
"address_2": "Suite 150",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495031055",
"country_code": "US",
"telephone_number": "616-459-6331",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "WAYNE",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2019-11-21",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101011102",
"primary": false
},
{
"code": "2083X0100X",
"taxonomy_group": "",
"desc": "Preventive Medicine, Occupational Medicine",
"state": "MI",
"license": "5101011102",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4615238",
"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 Nov 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.