NPIMap

Organization Active NPI

West Michigan Cardiology, PC

  • Specialist
  • Grand Rapids, MI
National Provider Identifier
1780770859
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
TM058656 Issued in MI
Legal business name
WEST MICHIGAN CARDIOLOGY, PC
Practice address
3210 Eagle Run Dr NE Ste 100
Grand Rapids, MI 49525-7051
Phone
(616) 456-9553
Fax
(616) 454-5371
NPI assigned
Oct 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Megan A TaratutaNPI 1619119393
Title
Practice Manager
Phone
(616) 456-9553

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
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X TM058656 MI Primary

Addresses

Primary practice location

3210 Eagle Run Dr NE Ste 100
Grand Rapids, MI 49525-7051

Mailing address

PO Box 150036
Grand Rapids, MI 49515-0036
Phone (616) 456-9553

Other practice location 1

743 E Beltline Ave NE
Grand Rapids, MI 49525-6045
Phone (616) 456-9553

Other practice location 2

3210 Eagle Run Dr NE
Grand Rapids, MI 49525-7051
Phone (616) 456-9553

Other practice location 3

20095 Gilbert Rd
Big Rapids, MI 49307-2365
Phone (616) 754-9146

Other practice location 4

709 S Greenville West Dr
Greenville, MI 48838-3514
Phone (616) 754-9146

Other identifiers 2

IdentifierTypeStateIssuer
060E960210OtherMIBLUE SHIELD
161OtherMIPRIORITY HEALTH

Other names 1

  • West Michigan Cardiology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040504000919 MI Part B Supplier - Clinic/Group Practice 3072501436 Receives reassigned benefits from 17 practitioners
Practice locations: Big Rapids, MI; Grand Rapids, MI; Greenville, MI
O20231017002316 MI Part B Supplier - Intensive Cardiac Rehabilitation 3072501436 Receives reassigned benefits from 1 practitioner
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Rapids, MI

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

3210 Eagle Run Dr NE
Ste 200
Grand Rapids, MI 49525
Phone (616) 279-3725

705 S Greenville West Dr
Ste 101
Greenville, MI 48838
Phone (616) 456-9553

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 26

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

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1780770859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 150036",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495150036",
            "telephone_number": "616-456-9553",
            "fax_number": "616-454-5371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3210 EAGLE RUN DR NE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257051",
            "telephone_number": "616-456-9553",
            "fax_number": "616-454-5371"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "743 E Beltline Ave NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495256045",
            "country_code": "US",
            "telephone_number": "616-456-9553",
            "fax_number": "616-454-5371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3210 Eagle Run Dr NE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495257051",
            "country_code": "US",
            "telephone_number": "616-456-9553",
            "fax_number": "616-454-5371",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20095 Gilbert Rd",
            "address_purpose": "LOCATION",
            "city": "Big Rapids",
            "state": "MI",
            "postal_code": "493072365",
            "country_code": "US",
            "telephone_number": "616-754-9146",
            "fax_number": "616-754-9152",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "709 S Greenville West Dr",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "MI",
            "postal_code": "488383514",
            "country_code": "US",
            "telephone_number": "616-754-9146",
            "fax_number": "616-754-9152",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "WEST MICHIGAN CARDIOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-05",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "TARATUTA",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "616-456-9553"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "TM058656",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "060E960210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "161",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Michigan Cardiology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 May 14, 2024; 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.