Jeremy Bradford Petrous, DO

Primary specialty

Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X

License

5101021240 Issued in MI

Practice address

4100 Lake Dr SE Ste 200
Grand Rapids, MI 49546

Phone

(616) 391-3759

NPI assigned

Jun 24, 2014

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

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

Psychiatry

Education

Michigan State University College of Osteopathic Medicine, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
• Corewell Health Pennock Hospital Hospital, Hastings, MI, CCN 231339
• Corewell Health Zeeland Hospital Hospital, Zeeland, MI, CCN 230003
• Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jpetrous144703@epic00.corewelldirect.org

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.

• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment Care Compare group NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation
• Spectrum Health United

  • General Acute Care Hospital
  • Greenville, MI
  • NPI 1457304495
  Care Compare affiliation
• Zeeland Community Hospital

  • General Acute Care Hospital
  • Zeeland, MI
  • NPI 1275536344
  Care Compare affiliation

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

{
    "created_epoch": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614211200000",
    "number": "1639584196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE DR SE STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-391-3759"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Medical Dr",
            "address_purpose": "LOCATION",
            "city": "Lebanon",
            "state": "NH",
            "postal_code": "03756",
            "country_code": "US",
            "telephone_number": "603-650-3156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETROUS",
        "first_name": "JEREMY",
        "middle_name": "BRADFORD",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2021-02-25",
        "certification_date": "2021-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5101021240",
            "primary": false
        },
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": "MI",
            "license": "5101021240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "4100 Lake Dr SE Ste 200",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49546",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jpetrous144703@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "4100 Lake Dr SE Ste 200",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49546",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Amber Petisce
• Raven Petrella
• Brian K Petroelje, MD
• Carly Petroelje
• Joseph Anthony Petronio, MD
• Steven Peter Petrovas, M.D.
• Amanda Petrovich
• Jerry Alvin Petrovich, MSW
• Breanna Marie Petrucciani, MS, RDN
• Lauren Petruska

• Sleep Medicine (Internal Medicine) Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Sleep Medicine (Internal Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2021; 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.