Individual provider Active NPI

Raul Rodriguez Montiague, M.D.

  • Anesthesiology Physician
  • Grand Rapids, MI
National Provider Identifier
1700919024
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301091372 Issued in MI
Practice address
3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone
(616) 364-4200
Fax
(616) 364-7347
NPI assigned
Mar 14, 2007
Last updated
Jul 3, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301091372 MI Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 34832 IA

Addresses

Primary practice location

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493

Mailing address

3333 Evergreen Dr NE
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

Other identifiers 4

IdentifierTypeStateIssuer
1284133MedicaidIA
M38730025OtherMIMEDICARE PART B
RM091372OtherMIBCBS
05-0-41-1822-1OtherMIBCBS PIN

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
I20080207000324 MI Practitioner - AnesthesiologyPractitioner - Pain Management 6204851603 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
AnesthesiologyAlso: Pain Management
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Medical Consultants, PCGroup PAC ID 3678751658, 87 clinicians

Practice addresses (Care Compare)

4055 Cascade Rd SE
Metro Health Park East Outpatient Surgical
Grand Rapids, MI 49546-2149
Phone (616) 364-4200

5900 Byron Ctr Ave SW
Metro Health Hospital
Wyoming, MI 49519-9606
Phone (616) 364-4200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
34832IAMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Medical Consultants, PC Anesthesiology CurrentSince Jul 1, 2011 Accepting new patients
West Michigan Anesthesia, PC Anesthesiology CurrentSince Aug 1, 2009 Accepting new patients

Locations

3333 Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 284-3132

3333 Evergreen Dr NE
Ste 100
Grand Rapids, MI 49525

4055 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 252-4410

80 68th St SE
Kentwood, MI 49548
Phone (616) 391-8220

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1173830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1700919024",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTIAGUE",
        "first_name": "RAUL",
        "middle_name": "RODRIGUEZ",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-14",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301091372",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IA",
            "license": "34832",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1284133",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "M38730025",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "RM091372",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PIN",
            "identifier": "05-0-41-1822-1",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.