Active NPI
Brian Willis Swanton, MD
- General Practice Physician
- Lake Odessa, MI
National Provider Identifier
1972612547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Physician
- License
- 4301035130
- Practice address
- 4294 Laurel Dr
Lake Odessa, MI 48849-9423 - Phone
- (616) 374-7660
- Fax
- (616) 374-0270
- NPI assigned
- Aug 29, 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 |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 4301035130 | MI | Primary |
Addresses
Primary practice location
4294 Laurel Dr
Lake Odessa, MI 48849-9423
Mailing address
4294 Laurel Dr
P.O. Box 578
Lake Odessa, MI 48849-9423
Phone (616) 374-7660
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2817978 | Medicaid | MI | |
| 382376508 | Other | MI | TAX IDENTIFICATION |
| 0348293 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| BS035130 | Other | MI | STATE LICENSE MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pennock Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Corewell Health Pennock Hospital Professional
- Family Medicine Physician
- Hastings, MI
- NPI 1518186295
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156809600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1972612547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4294 LAUREL DR",
"address_2": "P.O. BOX 578",
"city": "LAKE ODESSA",
"state": "MI",
"postal_code": "488499423",
"telephone_number": "616-374-7660",
"fax_number": "616-374-0270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4294 LAUREL DR",
"city": "LAKE ODESSA",
"state": "MI",
"postal_code": "488499423",
"telephone_number": "616-374-7660",
"fax_number": "616-374-0270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SWANTON",
"first_name": "BRIAN",
"middle_name": "WILLIS",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208D00000X",
"taxonomy_group": "",
"desc": "General Practice",
"state": "MI",
"license": "4301035130",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2817978",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX IDENTIFICATION",
"identifier": "382376508",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "0348293",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE MI",
"identifier": "BS035130",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Odessa, MI
- Julie M Powell, OD
- Simple Truth Chiropractic of Lake Odessa
- Spectrum Health Primary Care Partners (Corewell Health Medical Group West)
- Spectrum Health United
- Lee O Stuart, MD
- Christine Margaret Thomas, RPH
- Total Health Center Hastings Inc
- Michelle Vanburen, NP
- Wesley Burdette Vandenburg, MA IN COUNSELING
- William H Walker, RPH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.