Individual provider Active NPI

Lee Patrick Heeringa, MD

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1972869048
Registry record updated Dec 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301109096 Issued in MI
Practice address
730 Grandville Ave SW
Grand Rapids, MI 49503-4920
Phone
(616) 685-8400
Fax
(616) 742-1322
NPI assigned
Apr 3, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301109096 MI Primary

Addresses

Primary practice location

730 Grandville Ave SW
Grand Rapids, MI 49503-4920

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008
Phone (616) 685-1808

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address lheeringa26243@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, MI2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20150917001149 NC Practitioner - Pediatric Medicine 5193032597
I20160601000529 MI Practitioner - Pediatric Medicine 5193032597 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301109096MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 11, 2016 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 11, 2016 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Saint Mary'S Health Services Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

730 Cesar E Chavez Ave SW
Grand Rapids, MI 49503
Phone (616) 685-8400

1900 44th St SE
Kentwood, MI 49508
Phone (616) 685-8500

475 S State St
Sparta, MI 49345
Phone (616) 685-1300

Interoperability endpoints

  • Direct secure messaging: lheeringa26243@direct.trinity-health.org

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1333411200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638748800000",
    "number": "1972869048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-8099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 GRANDVILLE AVE SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034920",
            "telephone_number": "616-685-8400",
            "fax_number": "616-742-1322"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEERINGA",
        "first_name": "LEE",
        "middle_name": "PATRICK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-04-03",
        "last_updated": "2021-12-06",
        "certification_date": "2021-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301109096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lheeringa26243@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "730 Grandville Ave SW",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495034920",
            "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.