Active NPI
Justin Blaauwendraat, M.D.
- Family Medicine Physician
- Grand Rapids, MI
National Provider Identifier
1902289697
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 4301107794
- Practice address
- 300 Lafayette Ave SE
Suite 4000
Grand Rapids, MI 49503-4692 - Phone
- (616) 685-6922
- NPI assigned
- Jun 30, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301107794 | MI | Primary |
Addresses
Primary practice location
300 Lafayette Ave SE
Suite 4000
Grand Rapids, MI 49503-4692
Mailing address
300 Lafayette Ave SE
Suite 4000
Grand Rapids, MI 49503-4692
Phone (616) 685-6922
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435622400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1435622400000",
"number": "1902289697",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 LAFAYETTE AVE SE",
"address_2": "SUITE 4000",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034692",
"telephone_number": "616-685-6922"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 LAFAYETTE AVE SE",
"address_2": "SUITE 4000",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034692",
"telephone_number": "616-685-6922"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLAAUWENDRAAT",
"first_name": "JUSTIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-30",
"last_updated": "2015-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "4301107794",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.