Fredric Alan Reyelts, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301051511 Issued in MI

Practice address

801 Broadway Ave NW Ste 105
Grand Rapids, MI 49504-4496

Phone

(616) 685-7500

Fax

(616) 785-7511

NPI assigned

May 18, 2006

Last updated

Jun 7, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 7

Electronic endpoints 1

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 Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: fredric.reyelts@799501387825156.direct.elationemr.com
• Direct secure messaging: freyelts26248@direct.trinity-health.org
• FHIR API: https://api.platform.athenahealth.com/13864/brand/1/csg/1/fhir/r4

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.

• Advantage Health/Saint Mary's Medical Group

  dba Trinity Health Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1376862151
  Medicare reassignment NPD
• Mercy Physician Network

  • Family Medicine Physician
  • Muskegon, MI
  • NPI 1023056744
  Medicare reassignment NPD
• Reliance Community Care Partners

  dba Reliance Integrated Wellness Center

  • Psychiatry Physician
  • Grand Rapids, MI
  • NPI 1861045775
  Medicare reassignment NPD
• Sageoak Health PLLC

  • Family Medicine Physician
  • Rockford, MI
  • NPI 1063292852
  NPD Authorized official
• Advantage Health Saint Mary's Medical Group

  dba Trinity Health Medical Group Orthopedics Grand Rapids

  • Orthopaedic Surgery Physician
  • Byron Center, MI
  • NPI 1003515008
  NPD
• Mercy Physician Network

  dba Fruitport Family Medicine

  • Family Medicine Physician
  • Fruitport, MI
  • NPI 1639502701
  NPD
• Reliance Community Care Partners

  • Case Management Agency
  • Grand Rapids, MI
  • NPI 1417005257

  Psychiatry

  NPD
• Advantage Health Physicians PC

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1386695252
  NPD (past)
• Saint Mary's Health Services

  dba Mercy Health Saint Mary's

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  NPD (past)
• Frederick Health Hospital Inc

  dba Frederick Health Hospital

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686096000000",
    "number": "1285687467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BROADWAY AVE NW STE 105",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044496",
            "telephone_number": "616-685-7500",
            "fax_number": "616-685-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY AVE NW STE 105",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495044496",
            "telephone_number": "616-685-7500",
            "fax_number": "616-785-7511"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2100 Raybrook St SE Ste 203",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495465783",
            "country_code": "US",
            "telephone_number": "616-954-1555",
            "fax_number": "616-954-1520",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "REYELTS",
        "first_name": "FREDRIC",
        "middle_name": "ALAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2023-06-07",
        "certification_date": "2023-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301051511",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301051511",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "MI",
            "license": "4301051511",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2995094",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4593060",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3415813",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4878865",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4106189",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4155657",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4593050",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "freyelts26248@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health West MI Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "801 Broadway Ave NW Ste 105",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495044496",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Michelle A. Rewa, ACNP
• Christina Rexford, OD
• Diane Rexford, NP
• Elizabeth Anjali Rexroat, MS/OTR/L
• F Scott Reyburn, MSW LFMT
• Emmanuel Javier Reyes-Salavarria, M.D.
• Charlie Luise Mongcal Reyes
• Gimely Reyes
• Nicole Maria Reyes
• Jennifer Lynn Reygaert

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2023; 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.