John A Walen, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301045167 Issued in MI

Practice address

1211 Lafayette Ave NE
Grand Rapids, MI 49505-5092

Phone

(616) 336-8800

Fax

(616) 336-9700

NPI assigned

Jan 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Catherine's Health Center

  • Clinic/Center
  • Grand Rapids, MI
  • NPI 1912055872
  Authorized official Same address or phone

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

{
    "created_epoch": "1167955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465862400000",
    "number": "1922155332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1211 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055092",
            "telephone_number": "616-336-8800",
            "fax_number": "616-336-9700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1211 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495055092",
            "telephone_number": "616-336-8800",
            "fax_number": "616-336-9700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALEN",
        "first_name": "JOHN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-05",
        "last_updated": "2016-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301045167",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4502600",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "23330",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Waldron
• Matthew David Waldrop, MD
• Melinda June Waldrop, MD
• James Walejewski, ATC
• Annette Z Walen, M.D.
• Jennifer F Walenga, PA-C
• Walgreen Co (Walgreens #15007)
• Walgreen Co (Walgreens #15466)
• Walgreen Co (Walgreens #03426)
• Walgreen Co (Walgreens #12561)

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.