NPIMap

Organization Active NPI

Spectrum Health

  • Ambulatory Surgical Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1811983000
Registry record updated Jul 29, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
416835 Issued in MI
Legal business name
SPECTRUM HEALTH
Practice address
4069 Lake Dr SE
Suite 210
Grand Rapids, MI 49546-8816
Phone
(616) 285-1120
NPI assigned
Sep 22, 2005
Organization subpart
Yes
Parent organization
SPECTRUM HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 29, 2014

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

Authorized official

Name
Mr. Dougals D Welday
Title
VP Finance
Phone
(616) 391-2525

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 416835 MI Primary
Durable Medical Equipment & Medical Supplies 332B00000X

Addresses

Primary practice location

4069 Lake Dr SE
Suite 210
Grand Rapids, MI 49546-8816

Mailing address

100 Michigan St NE
MC 406
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

Other identifiers 2

IdentifierTypeStateIssuer
41034OtherMIBLUE CROSS
5170255MedicaidMI

Other names 1

  • Spectrum Health- Lake Drive Surgery Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Grand Rapids Pediatrics86 organizations share this tax ID, including this one
Part of
Corewell Health East

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1406592000000",
    "number": "1811983000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 406",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-1774",
            "fax_number": "616-774-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4069 LAKE DR SE",
            "address_2": "SUITE 210",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468816",
            "telephone_number": "616-285-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SPECTRUM HEALTH SYSTEM",
        "enumeration_date": "2005-09-22",
        "last_updated": "2014-07-29",
        "status": "A",
        "authorized_official_last_name": "WELDAY",
        "authorized_official_first_name": "DOUGALS",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "616-391-2525",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "416835",
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "41034",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170255",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Spectrum Health- Lake Drive Surgery Center",
            "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 Jul 29, 2014; 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.