Active NPI
Mary R Pell, D.O.
- Family Medicine Physician
- Grand Rapids, MI
National Provider Identifier
1629032800
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101009455
- Practice address
- 1471 Grace St SE
Grand Rapids, MI 49506-1678 - Phone
- (616) 913-2011
- Fax
- (616) 913-2005
- NPI assigned
- Apr 14, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101009455 | MI | Primary |
Addresses
Primary practice location
1471 Grace St SE
Grand Rapids, MI 49506-1678
Mailing address
1471 Grace St SE
Wyoming, MI 49506
Phone (616) 913-2006
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101009455 | MI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Enterprises Inc. | Family Medicine | Current | Accepting new patients |
| Metropolitan Hospital | Past | Accepting new patients |
Locations
4200 Division Ave N
Comstock Park, MI 49321
Phone (616) 252-1600
2215 44th St SW
Ste 100
Wyoming, MI 49519
Phone (616) 252-8300
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.
-
- Family Medicine Physician
- Wyoming, MI
- NPI 1770550105
-
- General Acute Care Hospital
- Wyoming, MI
- NPI 1619923919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1629032800",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1471 GRACE ST SE",
"city": "WYOMING",
"state": "MI",
"postal_code": "49506",
"telephone_number": "616-913-2006",
"fax_number": "616-913-2005"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 GRACE ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495061678",
"telephone_number": "616-913-2011",
"fax_number": "616-913-2005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PELL",
"first_name": "MARY",
"middle_name": "R",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-04-14",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101009455",
"primary": true
}
],
"identifiers": [],
"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 Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.