Active NPI
John Harrison Kopchick, M.D.
- Urology Physician
- Grand Rapids, MI
National Provider Identifier
1467497495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- 4301043886
- Practice address
- 2240 Teal CT SE
Grand Rapids, MI 49546-7939 - Phone
- (616) 635-1220
- NPI assigned
- Jun 16, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | 58797 | MN | |
| Urology Physician | 208800000X | 4301043886 | MI | Primary |
Addresses
Primary practice location
2240 Teal CT SE
Grand Rapids, MI 49546-7939
Mailing address
2240 Teal CT SE
Grand Rapids, MI 49546-7939
Phone (616) 635-1220
Other practice location 1
6849 Woodbrook Dr. SE
Grand Rapids, MI 49546
Phone (616) 635-1220
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3404100631 | Other | MI | BLUE CROSS BLUE SHIELD |
| 900002217 | Other | MI | PRIORITY HEALTH |
| 104135289 | Medicaid | MI |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521244800000",
"number": "1467497495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2240 TEAL CT SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495467939",
"telephone_number": "616-635-1220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2240 TEAL CT SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495467939",
"telephone_number": "616-635-1220"
}
],
"practiceLocations": [
{
"address_1": "6849 Woodbrook Dr. SE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "49546",
"country_code": "US",
"telephone_number": "616-635-1220",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KOPCHICK",
"first_name": "JOHN",
"middle_name": "HARRISON",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2018-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MN",
"license": "58797",
"primary": false
},
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "MI",
"license": "4301043886",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "3404100631",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "900002217",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "104135289",
"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 Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.