Individual provider Active NPI

Karl John Lauterbach, M.D.

  • Internal Medicine Physician
  • Holland, MI
National Provider Identifier
1902184666
Registry record updated Jul 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301099093 Issued in MI
Practice address
588 E Lakewood Blvd
Holland, MI 49424-2023
Phone
(616) 494-5800
NPI assigned
Jul 29, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4301099093 MI Primary

Addresses

Primary practice location

588 E Lakewood Blvd
Holland, MI 49424-2023

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

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
I20150813009996 MI Practitioner - Internal Medicine 4183939630 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Wayne State University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physician GroupGroup PAC ID 8628087681, 399 clinicians

Practice addresses (Care Compare)

4201 Saint Antoine St
Detroit, MI 48201-2153
Phone (313) 745-3000

Hospital & facility affiliations

  • Karmanos Cancer Center Hospital, Detroit, MI, CCN 230297
  • Harper University Hospital Hospital, Detroit, MI, CCN 230104
  • Detroit Receiving Hospital Hospital, Detroit, MI, CCN 230273

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301099093MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Trinity Health Grand Haven Hospital CurrentSince Sep 1, 2018 Accepting new patients
VHS Harper-Hutzel Hospital Inc Past Accepting new patients
Barbara Ann Karmanos Cancer Hospital Past Accepting new patients
University Physician Group Past Accepting new patients
VHS Detroit Receiving Hospital Inc Past Accepting new patients

Locations

1309 Sheldon Rd
Grand Haven, MI 49417
Phone (616) 842-3600

Interoperability endpoints

  • Direct secure messaging: karl.lauterbach.1@19711.direct.athenahealth.com

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 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": "1311897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719878400000",
    "number": "1902184666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "588 E LAKEWOOD BLVD",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242023",
            "telephone_number": "616-494-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUTERBACH",
        "first_name": "KARL",
        "middle_name": "JOHN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-29",
        "last_updated": "2024-07-02",
        "certification_date": "2024-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301099093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.