Individual provider Active NPI

Timothy L Todd, MD

  • Psychiatry Physician
  • Grand Rapids, MI
National Provider Identifier
1861518789
Registry record updated Jun 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301096165 Issued in MI
Practice address
3225 N Evergreen Dr NE
Grand Rapids, MI 49525-9334
Phone
(616) 364-1500
Fax
(616) 364-6400
NPI assigned
Mar 22, 2007
Last updated
Jun 5, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301096165 MI Primary

Addresses

Primary practice location

3225 N Evergreen Dr NE
Grand Rapids, MI 49525-9334

Mailing address

PO Box 165
Grand Rapids, MI 49501-0165
Phone (616) 455-5000

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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101026000328 MI Practitioner - Psychiatry 1557353174 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Psychiatry
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

300 SE 68TH St
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Jun 9, 2010 Accepting new patients
Community Mental Health for Central Michigan Psychiatry CurrentSince Feb 18, 2020 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jun 9, 2010 Accepting new patients
Scioto Paint Valley Mental Health Center Past Accepting new patients
Scioto Paint Valley Mental Health Center Past Accepting new patients

Locations

3225 N Evergreen Dr NE
Grand Rapids, MI 49525
Phone (616) 364-1500

301 S Crapo St
Ste 100
Mt Pleasant, MI 48858
Phone (989) 772-5938

301 S Crapo St
Ste 200
Mt Pleasant, MI 48858
Phone (989) 772-5938

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Interoperability endpoints

  • FHIR API: https://api.qualifacts.org/api/fhir/spvmhc/r4/

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1370390400000",
    "number": "1861518789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 165",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495010165",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3225 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259334",
            "telephone_number": "616-364-1500",
            "fax_number": "616-364-6400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TODD",
        "first_name": "TIMOTHY",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2013-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301096165",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.