NPIMap

Organization Active NPI

Spectrum Health United

  • General Practice Registered Nurse
  • Greenville, MI
National Provider Identifier
1376836221
Registry record updated Dec 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice Registered NurseTaxonomy code 163WG0000X
Legal business name
SPECTRUM HEALTH UNITED
Practice address
615 S Bower St
Greenville, MI 48838-2614
Phone
(616) 754-4691
NPI assigned
May 25, 2011
Last updated
Dec 26, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH UNITEDAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 26, 2013

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

Authorized official

Name
Ryan Johnson
Title
VP Finance
Phone
(616) 225-6310

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WG0000X MI Primary

Addresses

Primary practice location

615 S Bower St
Greenville, MI 48838-2614

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Phone (616) 486-6790

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040612000087 MI Part B Supplier - Clinic/Group Practice 6305836487 Receives reassigned benefits from 280 practitioners
5 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Belding, MI; Vestaburg, MI; Stanton, MI; Lakeview, MI; Howard City, MI; Greenville, MI; Carson City, MI; Blanchard, MI

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
United Memorial Hosp

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1306281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1388016000000",
    "number": "1376836221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-486-6790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 S BOWER ST",
            "city": "GREENVILLE",
            "state": "MI",
            "postal_code": "488382614",
            "telephone_number": "616-754-4691"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH UNITED",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH UNITED",
        "enumeration_date": "2011-05-25",
        "last_updated": "2013-12-26",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-225-6310"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, General Practice",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; 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.