Active NPI
Richard Phillip Oconnor Jr., MD
- Nephrology Physician
- Grand Rapids, MI
National Provider Identifier
1457462467
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- RO044045
- Practice address
- 4070 Lake Dr SE
Ste 201
Grand Rapids, MI 49546-8294 - Phone
- (616) 774-8200
- Fax
- (616) 774-0304
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | RO044045 | MI | Primary |
Addresses
Primary practice location
4070 Lake Dr SE
Ste 201
Grand Rapids, MI 49546-8294
Mailing address
PO Box 150185
Grand Rapids, MI 49515-0185
Phone (616) 866-2539
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3371432 | Medicaid | MI | |
| 044045 | Other | MI | MEDICAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RO044045 | MI | MD | Nephrology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Nephrology Consultants of Grand Rapids PC | Nephrology | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Nephrology Physician
- Grand Rapids, MI
- NPI 1528254877
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1222387200000",
"number": "1457462467",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 150185",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495150185",
"telephone_number": "616-866-2539",
"fax_number": "616-866-3135"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4070 LAKE DR SE",
"address_2": "STE 201",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468294",
"telephone_number": "616-774-8200",
"fax_number": "616-774-0304"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OCONNOR",
"first_name": "RICHARD",
"middle_name": "PHILLIP",
"name_suffix": "Jr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2008-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "MI",
"license": "RO044045",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3371432",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICAL LICENSE",
"identifier": "044045",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}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 Sep 26, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.