NPIMap

Organization Active NPI

Creekside Internal Medicine

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1235284076
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CREEKSIDE INTERNAL MEDICINE
Practice address
358 68TH St SW
Grand Rapids, MI 49548-7179
Phone
(616) 281-0463
Fax
(616) 281-0576
NPI assigned
Jan 24, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Dr. Khan Khan, M.D.
Title
President
Phone
(616) 954-0600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X MI Primary

Addresses

Primary practice location

358 68TH St SW
Grand Rapids, MI 49548-7179

Mailing address

358 68TH St SW
Grand Rapids, MI 49548-7179
Phone (616) 281-0463

Other identifiers 3

IdentifierTypeStateIssuer
1194836833OtherMINPI CHARLES ANDREWS, M.D.
1770545139OtherMINPI KELLY SCHROEDER, PA-C
1942311600OtherMINPI THEODOOR BEELS, M.D.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

358 68th St SW
Grand Rapids, MI 49548
Phone (616) 281-0547

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1235284076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "358 68TH ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495487179",
            "telephone_number": "616-281-0463",
            "fax_number": "616-281-0576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "358 68TH ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495487179",
            "telephone_number": "616-281-0463",
            "fax_number": "616-281-0576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREEKSIDE INTERNAL MEDICINE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-24",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "KHAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-954-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI CHARLES ANDREWS, M.D.",
            "identifier": "1194836833",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI KELLY SCHROEDER, PA-C",
            "identifier": "1770545139",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI THEODOOR BEELS, M.D.",
            "identifier": "1942311600",
            "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 Jul 21, 2022; 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.