Individual provider Active NPI

Walter Scott Metcalfe, MD

  • Family Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1225075898
Registry record updated Oct 1, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
058544 Issued in GA
Practice address
1246 Madison Ave SE
Grand Rapids, MI 49507-1761
Phone
(616) 913-8300
NPI assigned
Jun 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 1, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301074613 MI
Family Medicine Physician 207Q00000X 058544 GA Primary

Addresses

Primary practice location

1246 Madison Ave SE
Grand Rapids, MI 49507-1761

Mailing address

4959 Northside Dr
Atlanta, GA 30327-4419
Phone (770) 702-1735

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
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
I20231120002638 GA Practitioner - Family Practice 6709889934

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
058544GAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Access Medical Clinic Georgia LLC Family Medicine PastSince Aug 1, 2024 Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients
Pine Rest Christian Mental Health Services Past Accepting new patients

Organizations & group practices 3

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": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1569888000000",
    "number": "1225075898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4959 NORTHSIDE DR",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303274419",
            "telephone_number": "770-702-1735",
            "fax_number": "770-702-1753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1246 MADISON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495071761",
            "telephone_number": "616-913-8300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "METCALFE",
        "first_name": "WALTER",
        "middle_name": "SCOTT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-01",
        "last_updated": "2019-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074613",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "058544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.