NPIMap

Organization Active NPI

Spectrum Health Primary Care Partners

Doing business as Spectrum Health Medical Group CNP

  • Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1346480258
Registry record updated Mar 5, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
SPECTRUM HEALTH PRIMARY CARE PARTNERS
Doing business as
Spectrum Health Medical Group CNP
Practice address
3271 Clear Vista CT NE
Grand Rapids, MI 49525-9477
Phone
(616) 391-7800
NPI assigned
Mar 5, 2009
Last updated
Mar 5, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 5, 2009

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

Authorized official

Name
Tucci James
Title
President
Phone
(616) 391-2062

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

3271 Clear Vista CT NE
Grand Rapids, MI 49525-9477

Mailing address

PO Box 2864
Grand Rapids, MI 49501-2864

Other identifiers 1

IdentifierTypeStateIssuer
0D11193OtherMIBCBS GROUP PIN

Other names 1

  • SPECTRUM HEALTH MEDICAL GROUP CNP Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031121000091 MI Part B Supplier - Clinic/Group Practice 4587568647 Receives reassigned benefits from 3,022 practitioners
13 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

Other NPIs on the same Medicare enrollment 13

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 13

National Provider Directory

National Provider Directory
Part of
BMMC Ferguson Clinic

Practitioners & affiliated clinicians

Practitioners 52

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 52

NPI Registry JSON

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

{
    "created_epoch": "1236211200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1236211200000",
    "number": "1346480258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2864",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495012864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3271 CLEAR VISTA CT NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259477",
            "telephone_number": "616-391-7800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH PRIMARY CARE PARTNERS",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH HOSPITAL",
        "enumeration_date": "2009-03-05",
        "last_updated": "2009-03-05",
        "status": "A",
        "authorized_official_last_name": "JAMES",
        "authorized_official_first_name": "TUCCI",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-391-2062"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP  PIN",
            "identifier": "0D11193",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SPECTRUM HEALTH MEDICAL GROUP CNP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.