Thomas Provo Pfotenhauer Jr., D.O.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101020364 Issued in MI

Practice address

602 Michigan Ave
Holland, MI 49423-4918

Phone

(616) 355-3896

NPI assigned

May 6, 2013

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Specialty

HospitalistAlso: Internal Medicine

Education

Michigan State University College of Osteopathic Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holland Community HospitalGroup PAC ID 0446157291, 174 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holland Hospital Hospital, Holland, MI, CCN 230072
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

100

Improvement activities

40

Cost

89.24

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Holland Community Hospital

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Holland, MI
  • NPI 1780888099
  Medicare reassignment Care Compare group NPD
• Holland Community Hospital

  • Hospitalist Physician
  • Holland, MI
  • NPI 1497090617

  Internal Medicine

  NPD
• Holland Community Hospital

  • Family Medicine Physician
  • Hudsonville, MI
  • NPI 1952130585
  NPD
• Holland Community Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holland Community Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

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

{
    "created_epoch": "1367798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466121600000",
    "number": "1457796229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234918",
            "telephone_number": "616-355-3896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 MICHIGAN AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494234918",
            "telephone_number": "616-355-3896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PFOTENHAUER",
        "first_name": "THOMAS",
        "middle_name": "PROVO",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-05-06",
        "last_updated": "2016-06-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101020364",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Lynn Petre
• Danika Larae Petroelje, LMSW
• Jason Pettet, M.O.M.
• Jane Pettinga
• Stephen Pfahler, DC
• Pgpa LLC
• Dennis Hieu Pham, PHARMD
• Phares Family Dentistry
• Earl Knowles Phares Jr., DDS
• Thomas Chase Phares, DDS

• Internal Medicine Physician in Holland, MI
• Providers in Holland, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.