NPIMap

Organization Active NPI

Spectrum Health Hospitals

Doing business as Corewell Health Grand Rapids Hospitals Pediatric Dialysis

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Grand Rapids, MI
National Provider Identifier
1962494120
Registry record updated Oct 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
License
410040 Issued in MI
Legal business name
SPECTRUM HEALTH HOSPITALS
Doing business as
Corewell Health Grand Rapids Hospitals Pediatric Dialysis
DeVos Childrens Hospital End Stage Renal Disease
Practice address
35 Michigan St NE
Grand Rapids, MI 49503-2514
Phone
(616) 391-9000
NPI assigned
Aug 15, 2005
Last updated
Oct 16, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2023

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

Authorized official

Name
Mr. Matthew E Cox
Title
Vice President of Finance
Phone
(616) 391-1663

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 410040 MI
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X 410040 MI Primary

Addresses

Primary practice location

35 Michigan St NE
Grand Rapids, MI 49503-2514

Mailing address

100 Michigan St NE
MC 406
Grand Rapids, MI 49503-2560
Phone (616) 391-1774

Other identifiers 1

IdentifierTypeStateIssuer
4695800MedicaidMI

Other names 2

  • Corewell Health Grand Rapids Hospitals Pediatric Dialysis Doing business as
  • DeVos Childrens Hospital End Stage Renal Disease Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031211000325 MI Part A Provider - End-Stage Renal Disease Facility (ESRD) 8921904764 Practice locations: Grand Rapids, MI

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Devos Childrens Hosp - Dialysis UnitCCN 232345
Ownership
Non-profit
Certified
Aug 9, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
4

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2320972Corewell Health Grand Rapids Hospitals Pediatric35 Michigan Street NE Floor 2, Grand Rapids, MI 49503Certificate of waiverMar 26, 2027

National Provider Directory

National Provider Directory
Tax ID family
Grand Rapids Pediatrics88 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1124064000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1697414400000",
    "number": "1962494120",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE",
            "address_2": "MC 406",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-1774",
            "fax_number": "616-774-7699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "35 MICHIGAN ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032514",
            "telephone_number": "616-391-9000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTRUM HEALTH HOSPITALS",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-15",
        "last_updated": "2023-10-16",
        "certification_date": "2023-10-16",
        "status": "A",
        "authorized_official_last_name": "COX",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "616-391-1663",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MI",
            "license": "410040",
            "primary": false
        },
        {
            "code": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "MI",
            "license": "410040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4695800",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Corewell Health Grand Rapids Hospitals Pediatric Dialysis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DeVos Childrens Hospital End Stage Renal Disease",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Oct 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.