Individual provider Active NPI

Aileen Elizabeth M Ampil Antonio, M.D.

  • Neurology Physician
  • Grand Rapids, MI
National Provider Identifier
1982991683
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301097930 Issued in MI
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

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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 Other name

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
I20160816001533 MI Practitioner - NeurologyPractitioner - Ophthalmology 7214221191 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NeurologyAlso: Ophthalmology
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 499 clinicians

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 Hospital, Grand Rapids, MI, CCN 230059
  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301097930MIMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Sep 26, 2016 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Sep 26, 2016 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.

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

Verify at the official NPI Registry.