NPIMap

Individual provider Active NPI

Raymond P Rabideau, D.O.

  • Family Medicine Physician
  • Grand Haven, MI
National Provider Identifier
1356345698
Registry record updated Feb 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101008662 Issued in MI
Practice address
1310 Wisconsin Ave
Suite 301
Grand Haven, MI 49417-2472
Phone
(616) 847-1860
Fax
(616) 844-4537
NPI assigned
Jun 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101008662 MI Primary

Addresses

Primary practice location

1310 Wisconsin Ave
Suite 301
Grand Haven, MI 49417-2472

Mailing address

1310 Wisconsin Ave
Suite 101
Grand Haven, MI 49417-2472
Phone (616) 844-4528

Other identifiers 1

IdentifierTypeStateIssuer
11-5197731MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061006000352 MI Practitioner - Family Practice 3173425170 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Physician Network 109 clinicians

Practice addresses (Care Compare)

2006 Holton Rd
Muskegon, MI 49445-1505
Phone (231) 672-3333

Hospital & facility affiliations

  • Trinity Health at Home - Muskegon Home health agency, Muskegon, MI, CCN 237198
  • Trinity Health at Home - Grand Haven Hospice, Grand Haven, MI, CCN 231534
  • Harbor Hospice Hospice, Muskegon, MI, CCN 231508
  • Gentiva I Hospice, Grand Rapids, MI, CCN 231627
  • Trinity Health Grand Haven Hospital Hospital, Grand Haven, MI, CCN 230174
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Heartwood Lodge Trinity Health Nursing home, Spring Lake, MI, CCN 235373

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101008662MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Heartwood Lodge Trinity Health Past Accepting new patients
Grand Haven Opco LLC Past Accepting new patients
Atrium Hillcrest LLC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: rrabideau26242@direct.trinity-health.org

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.

Hospital & facility affiliations 9

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1454544000000",
    "number": "1356345698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "SUITE 101",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-844-4528",
            "fax_number": "616-847-5608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 WISCONSIN AVE",
            "address_2": "SUITE 301",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172472",
            "telephone_number": "616-847-1860",
            "fax_number": "616-844-4537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RABIDEAU",
        "first_name": "RAYMOND",
        "middle_name": "P",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-01",
        "last_updated": "2016-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101008662",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "11-5197731",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Haven, MI

Sources for this page

Verify at the official NPI Registry.