Maxwell Edward Rennaker, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

4901005238 Issued in MI

Practice address

2700 5 Mile Rd NE Ste 102
Grand Rapids, MI 49525-6516

Phone

(330) 908-8000

NPI assigned

May 31, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI, OH2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Care Associates of Marietta LLCGroup PAC ID 6608158696, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Care Associates of Marietta LLC

  • Optometrist
  • Marietta, OH
  • NPI 1033296868
  Medicare reassignment Care Compare group NPD
• Lakeshore Eyecare Center PC

  • Optometrist
  • Holland, MI
  • NPI 1760668016
  Medicare reassignment NPD
• Eye Care Associates of Belpre

  • Optometrist
  • Belpre, OH
  • NPI 1275610099
  Medicare reassignment NPD
• America'S Best Contacts & Eyeglasses

  • Optician
  • Macedonia, OH
  • NPI 1689971905
  NPD (past)

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

{
    "created_epoch": "1527724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599609600000",
    "number": "1366934879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3736 PRAIRIE ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181634",
            "telephone_number": "616-648-8456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 5 MILE RD NE STE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256516",
            "telephone_number": "330-908-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENNAKER",
        "first_name": "MAXWELL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-05-31",
        "last_updated": "2020-09-09",
        "certification_date": "2020-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "OPT.006660",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MI",
            "license": "4901005238",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kristy Michelle Rencher, M.ED.
• Renew Counseling Center
• Renewed Counseling Services
• Priya Rengaraj, PA-C
• Nancy Kathleen Renn-Bugai, CNM
• Madison Renne, RBT
• Patrick Renner
• Elisabeth Renshaw, LLMSW
• Sebastian Renteria Bishop
• Alexandra Rentz

• Optometrist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Optometrist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2020; 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.

Verify at the official NPI Registry.