Active NPI
Steven Ottenweller, MD
- Surgery Physician
- Grand Rapids, MI
National Provider Identifier
1942257399
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 4301032879
- Practice address
- 2750 E Beltline Ave NE
Attn: Occ Health Office
Grand Rapids, MI 49525-8614 - Phone
- (616) 447-5870
- Fax
- (616) 391-7733
- NPI assigned
- May 30, 2006
- 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 4301032879 | MI | Primary |
Addresses
Primary practice location
2750 E Beltline Ave NE
Attn: Occ Health Office
Grand Rapids, MI 49525-8614
Mailing address
100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170505000373 | MI | Order and Referring Only - Preventive Medicine | 8022906593 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Spectrum Health Primary Care Partners | Past | Accepting new patients | |
| Michigan Medical Patient Care | Past | Accepting new patients |
Organizations & group practices 2
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.
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- Grand Rapids, MI
- NPI 1689499667
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1405900800000",
"number": "1942257399",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"address_2": "MC 845",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2750 E BELTLINE AVE NE",
"address_2": "ATTN: OCC HEALTH OFFICE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495258614",
"telephone_number": "616-447-5870",
"fax_number": "616-391-7733"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OTTENWELLER",
"first_name": "STEVEN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-30",
"last_updated": "2014-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MI",
"license": "4301032879",
"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 Jul 21, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.