NPIMap

Individual provider Active NPI

Charles Edward Swallow, M.D.

  • Diagnostic Radiology Physician
  • Grand Rapids, MI
National Provider Identifier
1497752448
Registry record updated May 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
4301501168 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7339
Fax
(616) 361-5828
NPI assigned
Jul 6, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 4, 2020

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Neuroradiology Physician 2085N0700X 260525-1205 UT
Diagnostic Radiology Physician 2085R0202X 260525-1205 UT
Diagnostic Radiology Physician 2085R0202X 4301501168 MI Primary

Addresses

Primary practice location

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7339

Other practice location 1

1175 E 50 S Ste 141
American Fork, UT 84003-2845
Phone (801) 429-5996

Other practice location 2

1055 N 500 W Ste 112
Provo, UT 84604-3305
Phone (801) 812-4624

Other identifiers 8

IdentifierTypeStateIssuer
100505539MedicaidNV
924458MedicaidAZ
8127936MedicaidCA
120391600MedicaidWY
D1508MedicaidUT
P00651563OtherUTRR MEDICARE
003921900MedicaidID
P00199656OtherUTRR MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, MI2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20041209000475 UT Practitioner - Diagnostic Radiology 4486610508 Reassigns benefits to 1 organization
I20200129001645 MI Practitioner - Diagnostic Radiology 4486610508 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Chicago, Pritzker School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

7601 S Siesta Hills CT
Sandy, UT 84093-6128
Phone (616) 363-7339

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Bronson Methodist Hospital Hospital, Kalamazoo, MI, CCN 230017
  • Mymichigan Medical Center Midland Hospital, Midland, MI, CCN 230222
  • Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021
  • Bronson Battle Creek Hospital Hospital, Battle Creek, MI, CCN 230075

Merit-based Incentive Payment System (MIPS)

Final score
90.33 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

Merit-based Incentive Payment System (MIPS)

Final score
95.17 of 100Reported as group
Quality
91.34
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
260525-1205UTMDNeuroradiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Radiology Services PC Diagnostic Radiology CurrentSince Mar 1, 2020 Accepting new patients
University Radiology Associates Neuroradiology PastSince Feb 1, 1997 Accepting new patients
Fairfax Radiological Consultants Diagnostic Radiology Past Accepting new patients
New Schryver LLC Past Accepting new patients
DRS Korsower & Pion Radiology PA Diagnostic Radiology Past Accepting new patients
Schryver Medical Sales and Marketing LLC Past Accepting new patients
Utah Imaging Centers LLC Past Accepting new patients
Community Radiology Associates Inc Diagnostic Radiology Past Accepting new patients
Montgomery-Community Magnetic Imaging CNTR LTD Partnership Diagnostic Radiology Past Accepting new patients

Locations

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

3264 N Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 391-6001

844 Washington Ave
Holland, MI 49423
Phone (616) 355-3820

Interoperability endpoints

  • Direct secure messaging: cswallow136912@direct.covenanthealthcare.com
  • Direct secure messaging: cswallow1154961@direct.hfhs.org

Organizations & group practices 9

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 8

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": "1120608000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588550400000",
    "number": "1497752448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1175 E 50 S Ste 141",
            "address_purpose": "LOCATION",
            "city": "American Fork",
            "state": "UT",
            "postal_code": "840032845",
            "country_code": "US",
            "telephone_number": "801-429-5996",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1055 N 500 W Ste 112",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043305",
            "country_code": "US",
            "telephone_number": "801-812-4624",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SWALLOW",
        "first_name": "CHARLES",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-06",
        "last_updated": "2020-05-04",
        "certification_date": "2020-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085N0700X",
            "taxonomy_group": "",
            "desc": "Radiology, Neuroradiology",
            "state": "UT",
            "license": "260525-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "UT",
            "license": "260525-1205",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MI",
            "license": "4301501168",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505539",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "924458",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8127936",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120391600",
            "state": "WY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "D1508",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00651563",
            "state": "UT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003921900",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00199656",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.