NPIMap

Individual provider Active NPI

Ronald Duemler, MD

  • Geriatric Medicine (Family Medicine) Physician
  • Grand Rapids, MI
National Provider Identifier
1679524284
Registry record updated Jul 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
4301050164 Issued in MI
Practice address
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone
(616) 685-1835
Fax
(616) 685-1846
NPI assigned
May 16, 2006
Last updated
Jul 7, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301050164 MI
Geriatric Medicine (Family Medicine) Physician 207QG0300X 4301050164 MI Primary

Addresses

Primary practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502

Mailing address

245 State St SE
Ste 228
Grand Rapids, MI 49503-4328
Phone (616) 685-1808

Other identifiers 3

IdentifierTypeStateIssuer
3489002MedicaidMI
4846834MedicaidMI
4877474MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060911000358 MI Practitioner - Family PracticePractitioner - Geriatric Medicine 0143224964 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Geriatric Medicine
Education
Rush Medical College of Rush University, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Saint Mary's Health ServicesGroup PAC ID 4981500436, 175 clinicians

Practice addresses (Care Compare)

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301050164MIMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Saint Mary's Health Services Family Medicine CurrentSince Jun 8, 2018 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
Saint Mary's Health Services CurrentSince Jun 8, 2018 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Holland Home Past Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients
Holland Home Past Accepting new patients
Trinity Health - Michigan Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

1471 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 685-3414

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

245 State St SE
Ste 1A
Grand Rapids, MI 49503

245 State St SE
Ste 228
Grand Rapids, MI 49503

260 Jefferson Ave SE
Ste 206
Grand Rapids, MI 49503
Phone (616) 752-5432

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

1900 44th St SE
Kentwood, MI 49508
Phone (616) 685-8500

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Holland Home - Raybrook ManorGrand Rapids, MI, CCN 235440 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 26, 2000
Jun 26, 2000
Holland Home-Breton Rehabilitation & Living CentreGrand Rapids, MI, CCN 235540 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 26, 2000
Jun 26, 2000
Edison Christian Life Services, Edison Christian Health CenterGrand Rapids, MI, CCN 235339 Skilled nursing facility Contracted Managing Employee Jan 1, 2016

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 9

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.

Hospital & facility affiliations 8

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309996800000",
    "number": "1679524284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "address_2": "STE 228",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034328",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-1835",
            "fax_number": "616-685-1846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUEMLER",
        "first_name": "RONALD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2011-07-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301050164",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MI",
            "license": "4301050164",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3489002",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4846834",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4877474",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.