Organization Active NPI

Retina Specialists of Michigan PC

  • Retina Specialist (Ophthalmology) Physician
  • Grand Rapids, MI
National Provider Identifier
1801048699
Registry record updated Jun 6, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Retina Specialist (Ophthalmology) PhysicianTaxonomy code 207WX0107X
Legal business name
RETINA SPECIALISTS OF MICHIGAN PC
Practice address
5030 Cascade Rd SE
Grand Rapids, MI 49546-3725
Phone
(616) 954-2020
Fax
(616) 949-0408
NPI assigned
Oct 13, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2022

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

Authorized official

Name
Heather Duhr
Title
Executive Director
Phone
(616) 466-7562

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X 4301077476 MI
Retina Specialist (Ophthalmology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207WX0107X Primary

Addresses

Primary practice location

5030 Cascade Rd SE
Grand Rapids, MI 49546-3725

Mailing address

5030 Cascade Rd SE
Grand Rapids, MI 49546-3725
Phone (616) 954-2020

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20081217000211 MI Part B Supplier - Clinic/Group Practice 9436211919 Receives reassigned benefits from 11 practitioners
Practice locations: Grand Rapids, MI; Holland, MI; Muskegon, MI

National Provider Directory

National Provider Directory

Locations

650 Linden St
Ste 5
Big Rapids, MI 49307
Phone (231) 796-0010

650 Linden St
Big Rapids, MI 49307
Phone (231) 796-0010

7800 US Highway 131 S
Cadillac, MI 49601
Phone (231) 775-9797

2757 Leonard St NE
Ste 200
Grand Rapids, MI 49525
Phone (616) 458-8063

1000 East Paris Ave SE
Ste LL1
Grand Rapids, MI 49546
Phone (616) 464-3430

2680 Leonard St NE
Ste 1
Grand Rapids, MI 49525
Phone (616) 224-1110

1362 S Point Pl
Ste 120
Holland, MI 49423
Phone (616) 954-2020

1362 S Pointe Rdg
Holland, MI 49423
Phone (616) 458-1187

1250 Mercy Dr
Ste 102
Muskegon, MI 49444
Phone (616) 954-2020

1250 Mercy Dr
Ste 120
Muskegon, MI 49444

950 Trade Centre Way
Ste 110
Portage, MI 49002

Interoperability endpoints

  • Direct secure messaging: aknapp@rsmi.intellechartdirect.net
  • Direct secure messaging: ekorot@rsmi.intellechartdirect.net
  • Direct secure messaging: kdehorn@rsmi.intellechartdirect.net
  • Direct secure messaging: aomari@rsmi.intellechartdirect.net

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1223856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1654473600000",
    "number": "1801048699",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5030 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463725",
            "telephone_number": "616-954-2020",
            "fax_number": "616-949-0408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5030 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495463725",
            "telephone_number": "616-954-2020",
            "fax_number": "616-949-0408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RETINA SPECIALISTS OF MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-13",
        "last_updated": "2022-06-06",
        "certification_date": "2022-06-06",
        "status": "A",
        "authorized_official_last_name": "DUHR",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-466-7562"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "MI",
            "license": "4301077476",
            "primary": false
        },
        {
            "code": "207WX0107X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology, Retina Specialist",
            "state": null,
            "license": null,
            "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 Jun 6, 2022; 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.