Kelly Richardson, MD05/

Primary specialty

Adolescent Medicine (Internal Medicine) PhysicianTaxonomy code 207RA0000X

License

4301079769 Issued in MI

Practice address

1200 56TH St SW
Wyoming, MI 49509-9704

Phone

(616) 243-5707

Fax

(616) 243-1170

NPI assigned

Aug 3, 2006

Last updated

Oct 18, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Specialty

Internal MedicineAlso: Pediatric Medicine

Education

Michigan State University College of Human Medicine, 2002

Medicare assignment

May accept Medicare assignment

Group practices

Brookville Pediatric and Internal Medicine, PCGroup PAC ID 0446273510, 3 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brookville Pediatric & Internal Medicine, PC

  • Pediatrics Physician
  • Wyoming, MI
  • NPI 1346200847

  Internal Medicine

  Medicare reassignment Care Compare group NPD
• Advantage Health Physicians PC

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1386695252

  Internal Medicine

  NPD (past)
• Saint Mary's Health Services

  dba Mercy Health Saint Mary's

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  NPD (past)
• Trinity Health - Michigan

  dba Heartside Health Clinic

  • Federally Qualified Health Center (FQHC)
  • Grand Rapids, MI
  • NPI 1902002272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318896000000",
    "number": "1548278971",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 56TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099704",
            "telephone_number": "616-243-5707",
            "fax_number": "616-243-1170"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 56TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099704",
            "telephone_number": "616-243-5707",
            "fax_number": "616-243-1170"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "KELLY",
        "credential": "MD05/",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2011-10-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301079769",
            "primary": false
        },
        {
            "code": "207RA0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Adolescent Medicine",
            "state": "MI",
            "license": "4301079769",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "381360529",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Katlyn Elizabeth Ribant, OTR
• Sara Marie Rice, LPC
• Richard a Maier LPC LLC (Parkview Counseling)
• Richard a. Switzer, M.D., P.C.
• Molly Richards
• Laura Richardson
• Kiesha Richcreek, LC
• Courtney Rickstad, PA-C
• Kaitlyn Natalie Riffle, PHARMD
• Drake James Riggs, OTR/L

• Adolescent Medicine (Internal Medicine) Physician in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Adolescent Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.