Advanced Medical Group

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

ADVANCED MEDICAL GROUP

Practice address

3360 Prospect St
Hudsonville, MI 49426-1420

Phone

(616) 669-6702

Fax

(616) 797-4025

NPI assigned

Oct 11, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Benjamin Eovaldi, DO

Title

Provider

Phone

(616) 669-6702

Specialties & licenses 1

Addresses

Other identifiers 4

Locations

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

{
    "created_epoch": "1570752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1580688000000",
    "number": "1932741907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3360 PROSPECT ST",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494261420",
            "telephone_number": "616-669-6702",
            "fax_number": "616-797-4025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3360 PROSPECT ST",
            "city": "HUDSONVILLE",
            "state": "MI",
            "postal_code": "494261420",
            "telephone_number": "616-669-6702",
            "fax_number": "616-797-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-11",
        "last_updated": "2020-02-03",
        "certification_date": "2020-02-03",
        "status": "A",
        "authorized_official_last_name": "EOVALDI",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "PROVIDER",
        "authorized_official_telephone_number": "616-669-6702",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI CONTROLLED SUBSTANCE",
            "identifier": "5315213606",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI OSTEOPATHIC MEDICAL LICENSE",
            "identifier": "5101019505",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI TYPE 1",
            "identifier": "1902155690",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH#",
            "identifier": "14554401",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• 161 Private Holdings LLC
• Leah Marie Adams, PT
• Adhdonline
• Advantage Health/Saint Mary'S Medical Group
• Delanie R Aguilar, LM CPM
• Amanda Stienstra LMSW LLC
• American Medical Supply LLC
• Daniel Anderson, PHARM.D.

• General Practice Physician in Hudsonville, MI
• Providers in Hudsonville, MI by specialty
• General Practice Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 3, 2020; 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.