NPIMap

Organization Active NPI

AMC Mobile Anesthesia, PC

  • Anesthesiology Physician
  • Grand Rapids, MI
National Provider Identifier
1376868372
Registry record updated Oct 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
AMC MOBILE ANESTHESIA, PC
Practice address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone
(616) 284-3180
Fax
(616) 284-3181
NPI assigned
Apr 1, 2010
Last updated
Oct 23, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST MICHIGAN ANESTHESIA ANESTHESIA, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 23, 2012

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

Authorized official

Name
Dr. James F Vandam, MDNPI 1841279536
Title
Executive Director
Phone
(616) 284-3100

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493

Mailing address

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 284-3180

Other names 1

  • AMC Mobile Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110329000600 MI Part B Supplier - Clinic/Group Practice 9830372812 Receives reassigned benefits from 35 practitioners
Practice locations: Grand Rapids, MI; Holland, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2008765AMC Mobile Anesthesia3333 Evergreen Drive NE, Grand Rapids, MI 49525Certificate of waiverJun 16, 2028

National Provider Directory

National Provider Directory
Part of
Anethesia Medical Consu

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

3112 N Wellness Dr
Holland, MI 49424
Phone (616) 284-3180

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 45

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 45

NPI Registry JSON

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

{
    "created_epoch": "1270080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350950400000",
    "number": "1376868372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-284-3180",
            "fax_number": "616-284-3181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-284-3180",
            "fax_number": "616-284-3181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMC MOBILE ANESTHESIA, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST MICHIGAN ANESTHESIA ANESTHESIA, PC",
        "enumeration_date": "2010-04-01",
        "last_updated": "2012-10-23",
        "status": "A",
        "authorized_official_last_name": "VANDAM",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-284-3100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AMC Mobile",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.