Active NPI
Ashlyn Sovereen, MD
- Pediatrics Physician
- Grand Rapids, MI
National Provider Identifier
1245925445
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4351051186
- Practice address
- 275 Michigan St NE FL 8
Grand Rapids, MI 49503-2531 - Phone
- (616) 391-8810
- NPI assigned
- Apr 5, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4351051186 | MI | Primary |
Addresses
Primary practice location
275 Michigan St NE FL 8
Grand Rapids, MI 49503-2531
Mailing address
275 Michigan St NE FL 8
Grand Rapids, MI 49503-2531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20230627001720 | MI | Order and Referring Only - Pediatric Medicine | 8628436417 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4351051186 | MI | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1680652800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739145600000",
"number": "1245925445",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "275 MICHIGAN ST NE FL 8",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "275 MICHIGAN ST NE FL 8",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032531",
"telephone_number": "616-391-8810"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOVEREEN",
"first_name": "ASHLYN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-04-05",
"last_updated": "2025-02-10",
"certification_date": "2025-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4351051186",
"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 Feb 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.