Individual provider Active NPI

Carlos Tavera, MD

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1942277348
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301059687 Issued in MI
Practice address
275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone
(616) 391-3777
Fax
(616) 391-3755
NPI assigned
Mar 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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 4301059687 MI Primary

Addresses

Primary practice location

275 Michigan St NE
Grand Rapids, MI 49503-2531

Mailing address

100 Michigan St NE
MC 845
Grand Rapids, MI 49503-2560

Other identifiers 1

IdentifierTypeStateIssuer
1104110752OtherMIBCBS

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address carlos.tavera@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

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
I20100105000771 MI Practitioner - Internal Medicine 9032250592 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health HospitalsGroup PAC ID 8921904764, 161 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

100 Michigan St Northeast
Corewell Health Grand Rapids Hospit
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone (616) 391-3777

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

Hospital & facility affiliations

  • Corewell Health Visiting Nurse Association Home health agency, Grand Rapids, MI, CCN 237007
  • Mary Free Bed at Home, LLC Home health agency, Grand Rapids, MI, CCN 237203
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Spectrum Health United Hospital Hospital, Greenville, MI, CCN 230035

Merit-based Incentive Payment System (MIPS)

Final score
90.39 of 100Reported as group
Quality
85.52
Promoting interoperability
100
Improvement activities
40
Cost
57.34

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301059687MIMDInternal Medicine Physician

Interoperability endpoints

  • Direct secure messaging: ctavera5509@epic00.corewelldirect.org

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.

Hospital & facility affiliations 5

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": "1141344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736726400000",
    "number": "1942277348",
    "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": "275 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032531",
            "telephone_number": "616-391-3777",
            "fax_number": "616-391-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVERA",
        "first_name": "CARLOS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-03",
        "last_updated": "2025-01-13",
        "certification_date": "2025-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301059687",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "1104110752",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "carlos.tavera@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "25 Michigan St NE",
            "address_2": "Suite 2100",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032515",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "25 Michigan St NE",
            "address_2": "Suite 2100",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032515",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.