Individual provider Active NPI

David Cullen, D.O.

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1841501418
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101018705 Issued in MI
Practice address
200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone
(616) 685-1818
NPI assigned
Jun 28, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 5101018705 MI
Internal Medicine Physician 207R00000X 5101018705 MI Primary

Addresses

Primary practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503

Mailing address

3880 Salem Lake Dr
Ste F
Long Grove, IL 60047-5292
Phone (847) 719-2220

Other practice location 1

3880 Salem Lake Dr
Ste F
Long Grove, IL 60047-5292
Phone (847) 719-2220 ext. 222

Other identifiers 1

IdentifierTypeStateIssuer
1841501418MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dcullen28539@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
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: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130731000303 MI Practitioner - HospitalistPractitioner - Internal Medicine 3678714862 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hospitalist
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050

250 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jun 1, 2014 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Jun 1, 2014 Accepting new patients
Mercy Specialty Services Internal Medicine CurrentSince Sep 1, 2020 Accepting new patients
Best Practices Inpatient Care,LTD Internal Medicine Past Accepting new patients
Saint Mary's Health Services Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

1900 44th St SE
Kentwood, MI 49508
Phone (616) 685-8500

1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027

Organizations & group practices 6

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

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1841501418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3880 SALEM LAKE DR",
            "address_2": "STE F",
            "city": "LONG GROVE",
            "state": "IL",
            "postal_code": "600475292",
            "telephone_number": "847-719-2220",
            "fax_number": "847-719-2265"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-685-1818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3880 Salem Lake Dr",
            "address_2": "STE F",
            "address_purpose": "LOCATION",
            "city": "Long Grove",
            "state": "IL",
            "postal_code": "600475292",
            "country_code": "US",
            "telephone_number": "847-719-2220 x222",
            "fax_number": "847-719-2265",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CULLEN",
        "first_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-28",
        "last_updated": "2023-03-07",
        "certification_date": "2021-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "5101018705",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101018705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1841501418",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dcullen28539@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health direct email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "200 Jefferson Ave SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.