George C-C Fogg, MD, PHD

Primary specialty

Pediatric Infectious Diseases PhysicianTaxonomy code 2080P0208X

License

4301078543 Issued in MI

Practice address

330 Barclay Ave NE
Suite 203
Grand Rapids, MI 49503-2556

Phone

(616) 391-2313

NPI assigned

Jul 27, 2006

Last updated

Mar 17, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

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

Specialty

Infectious DiseaseAlso: Pediatric Medicine

Education

Washington University School of Medicine, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: george.fogg@epic00.shdirect.org
• Direct secure messaging: gfogg104925@direct.covenanthealthcare.com
• Direct secure messaging: gfogg7211@epic00.corewelldirect.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673

  Pediatric Infectious Diseases

  Medicare reassignment Care Compare group NPD
• Bronson Methodist Hospital

  dba Bronson Medical Group

  • Hospitalist Physician
  • Kalamazoo, MI
  • NPI 1417961137
  Medicare reassignment NPD
• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1689499667
  NPD

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

{
    "created_epoch": "1153958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615939200000",
    "number": "1811901085",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 BARCLAY AVE NE",
            "address_2": "SUITE 203",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032556",
            "telephone_number": "616-391-2313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGG",
        "first_name": "GEORGE",
        "middle_name": "C-C",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-27",
        "last_updated": "2021-03-17",
        "certification_date": "2021-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301078543",
            "primary": false
        },
        {
            "code": "2080P0208X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Infectious Diseases",
            "state": "MI",
            "license": "4301078543",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4627622",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "330 Barclay Ave NE",
            "address_2": "Suite 203",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032556",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "George.Fogg@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "330 Barclay Ave NE",
            "address_2": "Suite 203",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• FMS Clyde Park South, LLC (Fresenius Kidney Care Clyde Park South)
• Hunter Logan Foco
• Kelsey Foco, LLMSW
• Aida S. Foerster, LLPC
• Dan Siegel Fogel, LMSW
• Laura L. Fogle, D.D.S., M.S.
• Karla Anne Foisy
• Keith J Foisy, LLMSW
• September Foisy
• Alisha Lee Foley, PA

• Pediatric Infectious Diseases Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Pediatric Infectious Diseases Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.