Individual provider Active NPI

Brooke Ella Bollin-Richards, M.D.

  • Obstetrics & Gynecology Physician
  • Grand Rapids, MI
National Provider Identifier
1770511461
Registry record updated Jun 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
4301080478 Issued in MI
Practice address
555 Midtowne Stret NE
Suite 400
Grand Rapids, MI 49503-5731
Phone
(616) 588-1200
Fax
(616) 588-1250
NPI assigned
Jun 29, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology Physician 207V00000X 4301080478 MI Primary

Addresses

Primary practice location

555 Midtowne Stret NE
Suite 400
Grand Rapids, MI 49503-5731

Mailing address

555 Midtowne Street NE
Suite 400
Grand Rapids, MI 49503-5731
Phone (616) 588-1200

Other identifiers 1

IdentifierTypeStateIssuer
4915323MedicaidMI

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
I20080225000158 MI Practitioner - Obstetrics/Gynecology 1355425729 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Medical College of Ohio, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Rapids Womens Health PCGroup PAC ID 8729162185, 21 clinicians

Practice addresses (Care Compare)

555 Midtown St NE
Suite 400
Grand Rapids, MI 49503-5731
Phone (616) 588-1200

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301080478MIMDObstetrics & Gynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Rapids Womens Health PC Obstetrics & Gynecology CurrentSince Jan 1, 2008 Accepting new patients
Spectrum Health Hospitals Past Accepting new patients

Locations

555 Midtowne St NE
Ste 400
Grand Rapids, MI 49503
Phone (616) 588-1200

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 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": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307404800000",
    "number": "1770511461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE STREET NE",
            "address_2": "SUITE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035731",
            "telephone_number": "616-588-1200",
            "fax_number": "616-588-1250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 MIDTOWNE STRET NE",
            "address_2": "SUITE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495035731",
            "telephone_number": "616-588-1200",
            "fax_number": "616-588-1250"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLIN-RICHARDS",
        "first_name": "BROOKE",
        "middle_name": "ELLA",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2011-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": "4301080478",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4915323",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.