Active NPI
Aileen Elizabeth M Ampil Antonio, M.D.
- Neurology Physician
- Grand Rapids, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurology Physician
- License
- 4301097930
- Practice address
- 245 Cherry St SE
Suite 204
Grand Rapids, MI 49503-4607 - Phone
- (616) 685-5050
- Fax
- (616) 685-3050
- NPI assigned
- Jul 1, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | 4301097930 | MI | Primary |
| Ophthalmology Physician | 207W00000X | 4301097930 | MI |
Addresses
Primary practice location
245 Cherry St SE
Suite 204
Grand Rapids, MI 49503-4607
Mailing address
1900 44TH St SE
Kentwood, MI 49508-5008
Other names 1
- Dr. Aileen Antonio-Santos
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160816001533 | MI | Practitioner - Neurology | 7214221191 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Neurology
- Education
- Other, 1999
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Advantage Health/Saint Mary'S Medical Group
Practice addresses (Care Compare)
10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000
220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050
250 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5600
Hospital & facility affiliations
- Mercy Health Saint Mary'S
- Spectrum Health
- Trinity Health Muskegon Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301097930 | MI | MD | Neurology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Health Saint Mary'S Medical Group | Current | Accepting new patients | |
| Advantage Health/Saint Mary'S Medical Group | Current | Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Current | Accepting new patients |
Locations
10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850
245 Cherry St SE
Ste 204
Grand Rapids, MI 49503
Phone (616) 685-3330
1900 44th St SE
Kentwood, MI 49508
Phone (616) 685-8500
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Grand Rapids, MI
- NPI 1376862151
MI
-
- Orthopaedic Surgery Physician
- Byron Center, MI
- NPI 1003515008
-
- Multi-Specialty Clinic/Center
- Grand Rapids, MI
- NPI 1952340911
Hospital & facility affiliations 4
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": "1309478400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476835200000",
"number": "1982991683",
"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",
"fax_number": "616-391-3130"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "245 CHERRY ST SE",
"address_2": "SUITE 204",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495034607",
"telephone_number": "616-685-5050",
"fax_number": "616-685-3050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANTONIO",
"first_name": "AILEEN ELIZABETH M",
"middle_name": "AMPIL",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-07-01",
"last_updated": "2016-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "MI",
"license": "4301097930",
"primary": true
},
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MI",
"license": "4301097930",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AILEEN",
"last_name": "ANTONIO-SANTOS",
"prefix": "DR.",
"credential": "M.D.",
"code": "5",
"type": "Other Name"
}
]
}
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 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- 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.