NPIMap

Organization Active NPI

Breast Health & Wellness Center PC

  • Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1710378989
Registry record updated Dec 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301070786 Issued in MI
Legal business name
BREAST HEALTH & WELLNESS CENTER PC
Practice address
655 Kenmoor Ave SE Ste 201
Grand Rapids, MI 49546-8604
Phone
(616) 920-0825
NPI assigned
Feb 10, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2023

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

Authorized official

Name
Colleen App, MDNPI 1649294091
Title
Owner
Phone
(616) 920-0825

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X 4301070786 MI Primary

Addresses

Primary practice location

655 Kenmoor Ave SE Ste 201
Grand Rapids, MI 49546-8604

Mailing address

655 Kenmoor Ave SE Ste 201
Grand Rapids, MI 49546-8604
Phone (616) 920-0825

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150504002146 MI Part B Supplier - Clinic/Group Practice 6406175041 Receives reassigned benefits from 10 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Locations

655 Kenmoor Ave SE
Ste 201
Grand Rapids, MI 49546
Phone (616) 920-0825

655 Kenmoor Ave SE
Ste 202
Grand Rapids, MI 49546

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702598400000",
    "number": "1710378989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468604",
            "telephone_number": "616-920-0825",
            "fax_number": "616-920-0830"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 KENMOOR AVE SE STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468604",
            "telephone_number": "616-920-0825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BREAST HEALTH & WELLNESS CENTER PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2023-12-15",
        "certification_date": "2023-12-15",
        "status": "A",
        "authorized_official_last_name": "APP",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-920-0825",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301070786",
            "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 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.