NPIMap

Organization Active NPI

West Shore Otolaryngology PC

Doing business as West Shore ENT & Allergy Grand Haven

  • Multi-Specialty Clinic/Center
  • Grand Haven, MI
National Provider Identifier
1871097782
Registry record updated Jul 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
WEST SHORE OTOLARYNGOLOGY PC
Doing business as
West Shore ENT & Allergy Grand Haven
Practice address
16760 Lincoln St
Grand Haven, MI 49417
Phone
(616) 935-3300
NPI assigned
Mar 23, 2018
Organization subpart
Yes
Parent organization
WEST SHORE OTOLARYNGOLOGY PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 2, 2018

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

Authorized official

Name
Arthur James Potter Jr., MD
Title
Vice President
Phone
(231) 739-9095

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary

Addresses

Primary practice location

16760 Lincoln St
Grand Haven, MI 49417

Mailing address

1450 Farr Rd Ste 5000
Norton Shores, MI 49444-7789
Phone (231) 739-9095

Other names 1

  • West Shore ENT & Allergy Grand Haven Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180430001754 MI Part B Supplier - Clinic/Group Practice 4284998154 Receives reassigned benefits from 11 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Fremont, MI; Grand Haven, MI; Norton Shores, MI

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
West Shore Otolaryngology PC3 organizations share this tax ID, including this one
Part of
West Shore Otolaryngology PC

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 9

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

NPI Registry JSON

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

{
    "created_epoch": "1521763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1530489600000",
    "number": "1871097782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1450 FARR RD STE 5000",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494447789",
            "telephone_number": "231-739-9095",
            "fax_number": "231-722-5147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16760 LINCOLN ST",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "49417",
            "telephone_number": "616-935-3300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST SHORE OTOLARYNGOLOGY PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST SHORE OTOLARYNGOLOGY PC",
        "enumeration_date": "2018-03-23",
        "last_updated": "2018-07-02",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ARTHUR",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "231-739-9095",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Shore ENT & Allergy Grand Haven",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Haven, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2018; 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.