Individual provider Active NPI

Virginia Ann Stoll-Tyrrell, D.O.

  • Emergency Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1518128255
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101022218 Issued in MI
Practice address
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone
(616) 685-6781
NPI assigned
Jun 24, 2008
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 5101022218 MI Primary

Addresses

Primary practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502

Mailing address

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-6781

Other names 1

  • Virginia Ann Stoll Former name

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
I20160624000137 MI Practitioner - Emergency Medicine 9335279546 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand River Emergency Medical Group PLCGroup PAC ID 3274425905, 41 clinicians

Practice addresses (Care Compare)

200 Jefferson Ave SE
Mercy Health St. Mary'S
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Mar 5, 2018 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Mar 5, 2018 Accepting new patients
Ihc-Swedishamerican Emergency Physicians, LLC Emergency Medicine PastSince Dec 15, 2019 Accepting new patients
Ihc-Swedishamerican Emergency Physicians, LLC Emergency Medicine PastSince Dec 15, 2019 Accepting new patients

Locations

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

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

Organizations & group practices 6

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 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": "1214265600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1518128255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-6781",
            "fax_number": "414-290-6755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-6781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STOLL-TYRRELL",
        "first_name": "VIRGINIA",
        "middle_name": "ANN",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-06-24",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101022218",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "VIRGINIA",
            "last_name": "STOLL",
            "middle_name": "ANN",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.