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
Organization subpart
Yes
Parent organization
WEST MICHIGAN ANESTHESIA ANESTHESIA, PCAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Dr. James F Vandam, MD
Title
Executive Director
Phone
(616) 284-3100

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.

Member of 1

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

Practitioners 44

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 44

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

Medicare participation

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

Medicare enrollment records 1

Medicare enrollment files
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

National Provider Directory

National Provider Directory
Part of
West Michigan Anesthesia PC

Locations

1425 Michigan St NE
Ste A
Grand Rapids, MI 49503
Phone (616) 233-0933

555 Midtowne St NE
Ste 302
Grand Rapids, MI 49503
Phone (616) 391-3315

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

Specialties & licenses 1

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

Addresses

NPPES NPI Registry

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 identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
0D10334OtherMIBCBS GRP PIN

Other names 1

NPPES NPI Registry
  • AMC Mobile Other name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Oct 23, 2012.

{
    "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GRP PIN",
            "identifier": "0D10334",
            "state": "MI"
        }
    ],
    "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.