Andrea Emma Van Pelt, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

4301095522 Issued in MI

Practice address

4070 Lake Drive SE
Suite 202
Grand Rapids, MI 49546

Phone

(616) 464-4420

Fax

(616) 464-4354

NPI assigned

Apr 4, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1362528000000",
    "number": "1285756148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4070 LAKE DRIVE SE SUITE 202",
            "address_2": "CENTER FOR BREAST & BODY CONTOURING",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-464-4420",
            "fax_number": "646-464-4354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4070 LAKE DRIVE SE",
            "address_2": "SUITE 202",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-464-4420",
            "fax_number": "616-464-4354"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN PELT",
        "first_name": "ANDREA",
        "middle_name": "EMMA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-04",
        "last_updated": "2013-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301095522",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Audrey Van Oene, LMSW
• Katherine Van Oeveren
• Courtney Ann Van Os, OTR/L
• Faith Van Oss, NP
• Katherine Rachel Van Oss, MD
• Elizabeth Joanne Van Portfliet, LPC, NCC
• Jake G Van Schaik
• Laurina Van Sloten
• Michele L Van Soelen, NP
• Catherine Marie Van Til, L.AC

• Plastic and Reconstructive Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2013; 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.