Individual provider Active NPI

Ewa D Komorowska-Timek, MD

  • Plastic and Reconstructive Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1710996319
Registry record updated Feb 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
License
4301095374 Issued in MI
Practice address
3855 Burton St SE Ste a
Grand Rapids, MI 49546-5816
Phone
(616) 323-3102
Fax
(616) 323-3061
NPI assigned
Aug 5, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery Physician 2086S0122X A77833 CA
Plastic and Reconstructive Surgery Physician 2086S0122X 4301095374 MI Primary

Addresses

Primary practice location

3855 Burton St SE Ste a
Grand Rapids, MI 49546-5816

Mailing address

3855 Burton St SE Ste a
Grand Rapids, MI 49546-5816
Phone (616) 323-3102

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
I20090826000428 MI Practitioner - Plastic and Reconstructive Surgery 2062416134 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Plastic and Reconstructive Surgery
Education
Stanford University School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health HospitalsGroup PAC ID 8921904764, 161 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

100 Michigan St Northeast
Corewell Health Grand Rapids Hospit
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone (616) 391-3777

3855 Burton St SE
Suite a
Grand Rapids, MI 49546-6147
Phone (616) 323-3102

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.39 of 100Reported as group
Quality
85.52
Promoting interoperability
100
Improvement activities
40
Cost
57.34

Procedures performed for Medicare patients

ProcedureNumber of procedures
Mastectomy1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advanced Plastic Surgery, PC CurrentSince Jul 22, 2013 Accepting new patients
Spectrum Health Hospitals CurrentSince Apr 26, 2010 Accepting new patients
Spectrum Health Hospitals CurrentSince Apr 26, 2010 Accepting new patients
Advanced Plastic Surgery, PC Past Accepting new patients
Advanced Plastic Surgery, PC Past Accepting new patients

Locations

3855 Burton St SE
Ste 4
Grand Rapids, MI 49546

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

275 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 267-7900

3855 Burton St SE
Ste A
Grand Rapids, MI 49546
Phone (616) 323-3102

4551 Cascade Rd SE
Ste D
Grand Rapids, MI 49546
Phone (616) 323-3102

330 Barclay Ave NE
Ste 104
Grand Rapids, MI 49503
Phone (616) 267-9823

4070 Lake Dr SE
Ste 202
Grand Rapids, MI 49546
Phone (616) 464-4420

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1710996319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465816",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3855 BURTON ST SE STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495465816",
            "telephone_number": "616-323-3102",
            "fax_number": "616-323-3061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOMOROWSKA-TIMEK",
        "first_name": "EWA",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "CA",
            "license": "A77833",
            "primary": false
        },
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301095374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.