Active NPI
Walter Lee Irving, D.O.
- Obstetrics & Gynecology Physician
- Grand Rapids, MI
National Provider Identifier
1528087756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Obstetrics & Gynecology Physician
- License
- 5101006557
- Practice address
- 1925 Breton Rd SE
Grand Rapids, MI 49506-4810 - Phone
- (616) 252-4100
- Fax
- (616) 252-4953
- NPI assigned
- Jul 19, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician | 207V00000X | 5101006557 | MI | Primary |
Addresses
Primary practice location
1925 Breton Rd SE
Grand Rapids, MI 49506-4810
Mailing address
1925 Breton Rd SE
Grand Rapids, MI 49506-4810
Phone (616) 252-4100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5101006557 | Other | MI | STATE LICENSE NUMBER |
| 3054284 | 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 Osteopathy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Hospital | Past | Accepting new patients |
Interoperability endpoints
- walter.irving.1@21022.direct.athenahealth.com
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.
-
- Anatomic Pathology & Clinical Pathology Physician
- Wyoming, MI
- NPI 1336182542
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1276646400000",
"number": "1528087756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1925 BRETON RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495064810",
"telephone_number": "616-252-4100",
"fax_number": "616-252-4953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1925 BRETON RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495064810",
"telephone_number": "616-252-4100",
"fax_number": "616-252-4953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IRVING",
"first_name": "WALTER",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2010-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "207V00000X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology",
"state": "MI",
"license": "5101006557",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "5101006557",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3054284",
"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 Jun 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.