Individual provider Active NPI

Jordan Ray Johnson, MD

  • Emergency Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1891357810
Registry record updated Feb 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
4351045598 Issued in MI
Practice address
100 Michigan St NE
Grand Rapids, MI 49503-2560
Phone
(616) 975-1845
NPI assigned
Jun 29, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4351045598 MI
Emergency Medicine Physician 207P00000X 4351045598 MI Primary

Addresses

Primary practice location

100 Michigan St NE
Grand Rapids, MI 49503-2560

Mailing address

4100 Embassy Dr SE Ste 400
Grand Rapids, MI 49546-2416

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
I20210928001334 MI Practitioner - Emergency Medicine 6507195864 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ecs Western Michigan PCGroup PAC ID 8628327384, 202 clinicians

Practice addresses (Care Compare)

212 S Sullivan Ave
Fremont, MI 49412-1548
Phone (866) 270-4203

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Oct 24, 2021 Accepting new patients
Ecs Western Michigan PC Anesthesiology CurrentSince Oct 1, 2021 Accepting new patients
Rightcare Clinic PC CurrentSince Apr 1, 2024 Accepting new patients
Spectrum Health Primary Care Partners Anesthesiology CurrentSince Oct 24, 2021 Accepting new patients
Ecs Central Michigan PC Emergency Medicine CurrentSince Jun 28, 2023 Accepting new patients
Visionary Medical Services PC Anesthesiology CurrentSince Nov 16, 2023 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients

Locations

212 S Sullivan Ave
Fremont, MI 49412
Phone (231) 924-1212

4100 Embassy Dr SE
Ste 400
Grand Rapids, MI 49546
Phone (616) 285-8075

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

743 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 456-9553

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

100 Michigan St NE
#49
Grand Rapids, MI 49503
Phone (616) 391-1680

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

Organizations & group practices 7

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 3

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": "1561766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740096000000",
    "number": "1891357810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-975-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JORDAN",
        "middle_name": "RAY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-29",
        "last_updated": "2025-02-21",
        "certification_date": "2025-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4351045598",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "4351045598",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.