Timothy Pancioli, DO

Primary specialty

Blood Banking & Transfusion Medicine PhysicianTaxonomy code 207ZB0001X

License

5101025981 Issued in MI

Practice address

1036 Fuller Ave NE
Grand Rapids, MI 49503-1304

Phone

(248) 898-5000

NPI assigned

May 19, 2017

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Michigan Blood

  • Clinical Medical Laboratory
  • Grand Rapids, MI
  • NPI 1154572881
  NPD (past)

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

{
    "created_epoch": "1495152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654128000000",
    "number": "1285161315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 HAWK CHASE CT",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495253305",
            "telephone_number": "248-255-1076"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1036 FULLER AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031304",
            "telephone_number": "248-898-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANCIOLI",
        "first_name": "TIMOTHY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-05-19",
        "last_updated": "2022-06-02",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "5101023083",
            "primary": false
        },
        {
            "code": "207ZB0001X",
            "taxonomy_group": "",
            "desc": "Pathology, Blood Banking & Transfusion Medicine",
            "state": "MI",
            "license": "5101025981",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randal A Palmitier, MD
• Jennifer Lea Pals, NP
• Lillian Venema Palsrok, CTRS
• Preetha Pamidighantam
• Elizabeth Grace Pancake, CGC
• Richard W Panek, DDS
• Garett Pangrazzi, M.D.
• Rina Paniagua, MLSW
• Nikki R Pantelin
• Anthony John Pantoja, M.D.

• Blood Banking & Transfusion Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Blood Banking & Transfusion Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; 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.

Verify at the official NPI Registry.