NPIMap

Organization Active NPI

Grand Rapids Addiction Medicine Specialists PC

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1780642355
Registry record updated Jul 31, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301047295 Issued in MI
Legal business name
GRAND RAPIDS ADDICTION MEDICINE SPECIALISTS PC
Practice address
4100 Lake Dr SE
Suite 305
Grand Rapids, MI 49546-8292
Phone
(616) 954-0600
Fax
(616) 954-1675
NPI assigned
May 3, 2006
Last updated
Jul 31, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2007

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

Authorized official

Name
Khan Javan Nedd, M.D.NPI 1043284219
Title
President
Phone
(616) 954-0600

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
Internal Medicine Physician 207R00000X 4301047295 MI Primary

Addresses

Primary practice location

4100 Lake Dr SE
Suite 305
Grand Rapids, MI 49546-8292

Mailing address

PO Box 1682
Grand Rapids, MI 49501-1682
Phone (616) 954-0600

National Provider Directory

National Provider Directory

Locations

1840 Wealthy St SE
Grand Rapids, MI 49506
Phone (616) 391-1730

223 68th St SE
Grand Rapids, MI 49548
Phone (616) 456-0855

4100 Lake Dr SE
Ste 305
Grand Rapids, MI 49546
Phone (616) 267-9200

Practitioners & affiliated clinicians

Practitioners 24

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 24

NPI Registry JSON

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185840000000",
    "number": "1780642355",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1682",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495011682",
            "telephone_number": "616-954-0600",
            "fax_number": "616-954-1675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE DR SE",
            "address_2": "SUITE 305",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468292",
            "telephone_number": "616-954-0600",
            "fax_number": "616-954-1675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RAPIDS ADDICTION MEDICINE SPECIALISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2007-07-31",
        "status": "A",
        "authorized_official_last_name": "NEDD",
        "authorized_official_first_name": "KHAN",
        "authorized_official_middle_name": "JAVAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-954-0600",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301047295",
            "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 Jul 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.