Individual provider Active NPI

Caleb Walters

  • Family Medicine Physician
  • Jenison, MI
National Provider Identifier
1427409937
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301500557 Issued in MI
Practice address
7782 20TH Ave
Jenison, MI 49428
Phone
(616) 685-8700
Fax
(616) 457-5567
NPI assigned
Jun 27, 2016
Last updated
Dec 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 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 4301500557 MI Primary

Addresses

Primary practice location

7782 20TH Ave
Jenison, MI 49428

Mailing address

7782 20TH Ave
Jenison, MI 49428-8524
Phone (616) 685-8700

Other practice location 1

300 Lafayette Ave SE
Grand Rapids, MI 49503-4692
Phone (616) 685-6922

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cwalters84661@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
I20190808002167 MI Practitioner - Family Practice 7214225432 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Indiana University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

7782 20TH Ave
Jenison, MI 49428-8524
Phone (616) 685-8700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301500557MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 30, 2019 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Jul 30, 2019 Accepting new patients
Saint Mary's Health Services Past Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients

Locations

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

7782 20th Ave
Jenison, MI 49428
Phone (616) 685-8700

Interoperability endpoints

  • Direct secure messaging: cwalters84661@direct.trinity-health.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1466985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1427409937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7782 20TH AVE",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288524",
            "telephone_number": "616-685-8700",
            "fax_number": "616-457-5567"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7782 20TH AVE",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "49428",
            "telephone_number": "616-685-8700",
            "fax_number": "616-457-5567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 Lafayette Ave SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495034692",
            "country_code": "US",
            "telephone_number": "616-685-6922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "CALEB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-27",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301500557",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cwalters84661@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "7782 20th Ave",
            "city": "Jenison",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49428",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jenison, MI

Sources for this page

Verify at the official NPI Registry.