Active NPI
David M Graham, MD
- Anatomic Pathology & Clinical Pathology Physician
- Grand Rapids, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anatomic Pathology & Clinical Pathology Physician
- License
- 4301407090
- Practice address
- 200 Jefferson Ave SE
Grand Rapids, MI 49503-4502 - Phone
- (616) 685-6258
- NPI assigned
- Sep 23, 2005
- 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 |
|---|---|---|---|---|
| Hematology (Pathology) Physician | 207ZH0000X | 4301407090 | MI | |
| Anatomic Pathology & Clinical Pathology Physician | 207ZP0102X | 4301407090 | MI | Primary |
Addresses
Primary practice location
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Mailing address
PO Box 1629
Lima, OH 45802-1629
Phone (877) 378-4293
Other practice location 1
5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-7166
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4933715 | Medicaid | MI |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | dgraham37933@direct.trinity-health.org | ||
| Direct Messaging Address | dgraham835@direct.metrohealth.net |
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
Care Compare profile
Medicare Care Compare- Specialty
- Pathology
- Education
- Wayne State University School of Medicine, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-7166
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301407090 | MI | MD | Anatomic Pathology & Clinical Pathology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diagnostic Pathology Services of Southwest Michigan PC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Patholgy Services of Kalamazoo, PC | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Pathology Associates of Grand Rapids, P.C. | Anatomic Pathology & Clinical Pathology | Current | Accepting new patients |
| Michigan Urological Clinic | Past | Accepting new patients |
Locations
200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000
601 John St
Kalamazoo, MI 49007
Phone (269) 341-7100
5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243
2122 Health Dr SW
Wyoming, MI 49519
Phone (616) 252-5950
5700 Southwyck Blvd
Toledo, OH 43614
Interoperability endpoints
- https://app.meldrx.com/api/fhir/uc29598_michiganurologicalclinic
- dgraham37933@direct.trinity-health.org
- dgraham2947735@carolinashealthcaresystem.direct-ci.com
Organizations & group practices 4
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Grand Rapids, MI
- NPI 1184636821
-
- Anatomic Pathology & Clinical Pathology Physician
- Kalamazoo, MI
- NPI 1548243595
-
- Anatomic Pathology & Clinical Pathology Physician
- Kalamazoo, MI
- NPI 1912241597
-
- Urology Physician
- Grand Rapids, MI
- NPI 1376586164
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Metro Health Hospital
- General Acute Care Hospital
- Wyoming, MI
- NPI 1619923919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127433600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1635811200000",
"number": "1285620435",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1629",
"city": "LIMA",
"state": "OH",
"postal_code": "458021629",
"telephone_number": "877-378-4293",
"fax_number": "419-223-2726"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 JEFFERSON AVE SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034502",
"telephone_number": "616-685-6258"
}
],
"practiceLocations": [
{
"address_1": "5900 Byron Center Ave SW",
"address_purpose": "LOCATION",
"city": "Wyoming",
"state": "MI",
"postal_code": "495199606",
"country_code": "US",
"telephone_number": "616-252-7166",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GRAHAM",
"first_name": "DAVID",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-23",
"last_updated": "2021-11-02",
"certification_date": "2021-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "207ZH0000X",
"taxonomy_group": "",
"desc": "Pathology, Hematology",
"state": "MI",
"license": "4301407090",
"primary": false
},
{
"code": "207ZP0102X",
"taxonomy_group": "",
"desc": "Pathology, Anatomic Pathology & Clinical Pathology",
"state": "MI",
"license": "4301407090",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4933715",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dgraham37933@direct.trinity-health.org",
"affiliation": "N",
"address_1": "200 Jefferson Ave SE",
"city": "Grand Rapids",
"state": "MI",
"country_code": "US",
"postal_code": "495034502",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "dgraham835@direct.metrohealth.net",
"affiliation": "N",
"address_1": "5900 Byron Center Ave SW",
"city": "Wyoming",
"state": "MI",
"country_code": "US",
"postal_code": "495199606",
"country_name": "United States",
"address_type": "DOM"
}
],
"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 2, 2021; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.