NPIMap

Organization Active NPI

Forest Hills Pediatric Associates, PC

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1699767343
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
FOREST HILLS PEDIATRIC ASSOCIATES, PC
Practice address
877 Forest Hill Ave SE
Grand Rapids, MI 49546-2325
Phone
(616) 949-4465
Fax
(616) 949-6191
NPI assigned
Aug 18, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Susan H Wakefield, MDNPI 1013909787
Title
Practice Manager
Phone
(616) 949-4465

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X Primary

Addresses

Primary practice location

877 Forest Hill Ave SE
Grand Rapids, MI 49546-2325

Mailing address

877 Forest Hill Ave SE
Grand Rapids, MI 49546-2325
Phone (616) 949-4465

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0380867Forest Hills Pediatric Associates, PC877 Forest Hill Avenue, SE, Grand Rapids, MI 49546Certificate of waiverNov 15, 2027

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 13

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1124323200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1699767343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "877 FOREST HILL AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462325",
            "telephone_number": "616-949-4465",
            "fax_number": "616-949-6191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 FOREST HILL AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462325",
            "telephone_number": "616-949-4465",
            "fax_number": "616-949-6191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREST HILLS PEDIATRIC ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAKEFIELD",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "616-949-4465",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "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 Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.