Individual provider Active NPI

Patricia Vanbaren, MD

  • Family Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1407809726
Registry record updated Dec 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301074503 Issued in MI
Practice address
730 Grandville Ave SW
Grand Rapids, MI 49503-4920
Phone
(616) 685-8400
Fax
(616) 742-1322
NPI assigned
May 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2021

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 4301074503 MI Primary

Addresses

Primary practice location

730 Grandville Ave SW
Grand Rapids, MI 49503-4920

Mailing address

245 State St SE
Grand Rapids, MI 49503-4328
Phone (616) 685-1808

Other identifiers 5

IdentifierTypeStateIssuer
4877367MedicaidMI
4878112MedicaidMI
4437056MedicaidMI
4437216MedicaidMI
4437225MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pvanbaren26246@direct.trinity-health.org Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041208000096 MI Practitioner - Family Practice 1850357179 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

730 Cesar E Chavez Ave SW
Grand Rapids, MI 49503-4920
Phone (616) 685-8400

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Dec 4, 2010 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Dec 4, 2010 Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients
Pine Rest Christian Mental Health Services Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

730 Cesar E Chavez Ave SW
Grand Rapids, MI 49503
Phone (616) 685-8400

245 State St SE
Grand Rapids, MI 49503
Phone (616) 685-1808

245 State St SE
Ste 1A
Grand Rapids, MI 49503

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

Organizations & group practices 5

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 1

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": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1407809726",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034328",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 GRANDVILLE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034920",
            "telephone_number": "616-685-8400",
            "fax_number": "616-742-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANBAREN",
        "first_name": "PATRICIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4877367",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4878112",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4437056",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4437216",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4437225",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pvanbaren26246@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Grand Rapids Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "730 Grandville Ave SW",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495034920",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.