Individual provider Active NPI

David Chester Haller, D.O.

  • Emergency Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1538422159
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
5101020022 Issued in MI
Practice address
80 68TH St SE
Grand Rapids, MI 49548
Phone
(616) 391-8242
Fax
(616) 391-8317
NPI assigned
Jun 19, 2012
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 20A16525 CA
Emergency Medicine Physician 207P00000X 5101020022 MI Primary

Addresses

Primary practice location

80 68TH St SE
Grand Rapids, MI 49548

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Phone (616) 391-8242

Other identifiers 1

IdentifierTypeStateIssuer
1538422159MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20140707001564 MI Practitioner - Emergency Medicine 9638394604 Reassigns benefits to 3 organizations
I20180731000179 CA Practitioner - Emergency Medicine 9638394604 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Michigan State University College of Osteopathic Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cep America - CaliforniaGroup PAC ID 6103739131, 1,278 clinicians

Practice addresses (Care Compare)

200 Mission Blvd
Jackson, CA 95642-2564
Phone (209) 223-7500

Hospital & facility affiliations

  • Sutter Roseville Medical Center Hospital, Roseville, CA, CCN 050309

Merit-based Incentive Payment System (MIPS)

Final score
96.69 of 100Reported as group
Quality
90
Improvement activities
40
Cost
78.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20A16525CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ascension Borgess Hospital CurrentSince Apr 4, 2015 Accepting new patients
Cep America - California Emergency Medicine CurrentSince Jul 1, 2018 Accepting new patients
Ascension Borgess Hospital CurrentSince Apr 4, 2015 Accepting new patients
Cep America - California Emergency Medicine Current Accepting new patients
Sound Physicians Emergency Medicine of Michigan, PLLC Emergency Medicine CurrentSince Apr 1, 2018 Accepting new patients
Hometown Urgent Care of Michigan, P.C. Current Accepting new patients
Cep America-California Emergency Medicine CurrentSince Jul 1, 2018 Accepting new patients

Locations

2100 Powell St
Ste 900
Emeryville, CA 94608
Phone (510) 350-2777

1650 Creekside Dr
Folsom, CA 95630
Phone (916) 983-7400

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

4445 Magnolia Ave
Riverside, CA 92501
Phone (800) 498-7156

1 Medical Plaza Dr
Roseville, CA 95661
Phone (916) 781-1000

4001 J St
Sacramento, CA 95819
Phone (916) 453-4037

1501 W Chisholm St
Alpena, MI 49707
Phone (989) 356-7000

420 W High St
Dowagiac, MI 49047
Phone (269) 782-8681

1634 Gull Rd
Kalamazoo, MI 49048
Phone (269) 903-2835

1521 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-5165

411 Naomi St
Plainwell, MI 49080
Phone (269) 685-0700

Interoperability endpoints

  • Direct secure messaging: dhaller424427@hisp.ehr.sutterhealth.org

Organizations & group practices 8

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": "1340064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530489600000",
    "number": "1538422159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-8242",
            "fax_number": "616-391-8317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49548",
            "telephone_number": "616-391-8242",
            "fax_number": "616-391-8317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLER",
        "first_name": "DAVID",
        "middle_name": "CHESTER",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-19",
        "last_updated": "2018-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "20A16525",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101020022",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538422159",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.