Individual provider Active NPI

Paul O Thieme Jr., DO

  • Radiation Oncology Physician
  • Grand Rapids, MI
National Provider Identifier
1568535938
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
010272 Issued in MI
Practice address
145 Michigan St NE Ste 1100
Grand Rapids, MI 49503-2562
Phone
(616) 486-5750
NPI assigned
Nov 15, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 010272 MI Primary

Addresses

Primary practice location

145 Michigan St NE Ste 1100
Grand Rapids, MI 49503-2562

Mailing address

1895 M 28 E
Marquette, MI 49855-9546
Phone (906) 249-4942

Other practice location 1

420 W Magnetic Street
Marquette, MI 49855
Phone (906) 228-9440

Other identifiers 1

IdentifierTypeStateIssuer
4565403MedicaidMI

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
I20040403000281 MI Practitioner - Radiation Oncology 4981696697 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Michigan State University College of Osteopathic Medicine, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Radiation Oncology Centers PCGroup PAC ID 2860437092, 9 clinicians

Practice addresses (Care Compare)

12642 Riley St
Holland, MI 49424-9202
Phone (616) 355-5330

145 Michigan St NE
Grand Rapids, MI 49503-2562
Phone (616) 486-5750

4499 220TH Ave
Reed City, MI 49677-8593
Phone (231) 832-5817

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Corewell Health Reed City Hospital Hospital, Reed City, MI, CCN 231323
  • Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339
  • Corewell Health Big Rapids Hospital Hospital, Big Rapids, MI, CCN 230093
  • Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
010272MIMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeshore Area Radiation Oncology Center Past Accepting new patients

Organizations & group practices 2

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 5

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": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1568535938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1895 M 28 E",
            "city": "MARQUETTE",
            "state": "MI",
            "postal_code": "498559546",
            "telephone_number": "906-249-4942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 1100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032562",
            "telephone_number": "616-486-5750"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "420 W Magnetic Street",
            "address_purpose": "LOCATION",
            "city": "Marquette",
            "state": "MI",
            "postal_code": "49855",
            "country_code": "US",
            "telephone_number": "906-228-9440",
            "fax_number": "906-225-3772",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "THIEME",
        "first_name": "PAUL",
        "middle_name": "O",
        "name_suffix": "Jr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "MI",
            "license": "010272",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4565403",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.