SPECTRUM HEALTH (NPI# 1811983000) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811983000 |
| Entity Type | Organization |
| Organization Name | SPECTRUM HEALTH |
| Other Organization Name | SPECTRUM HEALTH- LAKE DRIVE SURGERY CENTER |
| Practice Address |
4069 Lake Dr Se Suite 210 Grand Rapids MI 49546-8816 |
| Mailing Address |
100 Michigan St Ne Mc 406 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6162851120 |
| Mailing Telephone | 6163911774 |
| Mailing Fax Number | 6167747699 |
| Enumeration Date | 2005-09-22 |
| Last Update Date | 2014-07-29 |
| Authorized Official Name | MR. DOUGALS D WELDAY (VP FINANCE) |
| Authorized Official Telephone | 6163912525 |
| Is Organization Subpart | Y |
| Parent Organization Name | SPECTRUM HEALTH SYSTEM |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
416835 | MI | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | BLUE CROSS | 41034 | 01 |
| MI | 5170255 | 05 |
| Other Name | Type Code |
|---|---|
| Spectrum Health- Lake Drive Surgery Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356652481 | Spectrum Health | General Acute Care Hospital | 25850 Brolin Beach Rd, Detroit Lakes, MN 56501-7978 | 2010-06-23 |
| 1033505128 | Spectrum Health | Non-Pharmacy Dispensing Site | 1 N Atkinson Dr, Ludington, MI 49431-1906 | 2015-04-15 |
| 1205078920 | Spectrum Health | General Acute Care Hospital | 1840 Wealthy St Se, Grand Rapids, MI 49506-2921 | 2009-03-26 |
| 1134267867 | Spectrum Health | Chiropractor | 1108 W Parker Rd, Suite 110, Plano, TX 75075-4000 | 2007-02-02 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | SPECTRUM HEALTH | 100 Michigan Ave Ne, Grand Rapids, MI 49503-2560 |
| Oregon Corporations, Companies and Business Names | SPECTRUM HEALTH AND WELLNESS, PLLC | 7701 Ne Vancouver Plaza Dr, Vancouver, WA 98662 |
| Washington State Corporations | SPECTRUM HEALTH AND WELLNESS, PLLC | 1848 Nw Sierra Way, Camas, WA 98607-7251 |
| System for Award Management (SAM) Entities | SPECTRUM HEALTH CARE | 1123 Wilkes Blvd Ste 250, Columbia, MO 65201-4774 |
| Colorado Business Entities | Spectrum Health CBD Inc. | 1086 Fontmore Road, Apt. A, Colorado Springs, CO 80904 |
| System for Award Management (SAM) Entities | SPECTRUM HEALTH LAKELAND | 1234 Napier Ave, Saint Joseph, MI 49085-2112 |
| System for Award Management (SAM) Entities | SPECTRUM HEALTH MEDICAL GROUP | 1840 Wealthy St Se, Grand Rapids, MI 49506-2921 |
| System for Award Management (SAM) Entities | SPECTRUM HEALTH POLICY RESEARCH , LLC | 1670 Mckendree Church Rd Ste 60, Lawrenceville, GA 30043-6676 |
| North Carolina Corporations | Spectrum Health Systems Inc. | 3414 Six Forks Road, Raleigh, NC 27609 |
| Virginia Business Entities | Spectrum Health Systems Inc. | 10 Mechanic Street, Suite 302, Worcester, Massachusetts 01608 |
| Street Address |
4069 LAKE DR SE SUITE 210 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-8816 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184070807 | Danielle Wentworth | Audiologist | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2016-05-12 |
| 1205253424 | Elizabeth House | Physician Assistant | 4069 Lake Dr Se, Suite 312, Grand Rapids, MI 49546-8816 | 2014-03-26 |
| 1043655780 | Spectrum Health Primary Care Partners | Nutritionist | 4069 Lake Dr Se, Ste. 315, Grand Rapids, MI 49546-8816 | 2013-05-08 |
| 1790025898 | George Torao Sugiyama | Surgery | 4069 Lake Dr Se, Suite 312, Grand Rapids, MI 49546-8816 | 2013-02-26 |
| 1639442791 | Debra Ann West | Audiologist | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2012-02-20 |
| 1982976924 | Ashley Lucas | Physician Assistant | 4069 Lake Dr Se, Suite 117, Grand Rapids, MI 49546-8816 | 2012-02-07 |
| 1861762122 | Carley Therese Flegler | Physician Assistant | 4069 Lake Dr Se, Suite 313, Grand Rapids, MI 49546-8816 | 2012-01-04 |
| 1013227156 | Spectrum Health Primary Care Partners | Durable Medical Equipment & Medical Supplies | 4069 Lake Dr Se, Suite 315, Grand Rapids, MI 49546-8816 | 2010-10-07 |
| 1285944322 | Spectrum Health Primary Care Partners | Durable Medical Equipment & Medical Supplies | 4069 Lake Dr Se, Suite 314, Grand Rapids, MI 49546-8816 | 2010-10-07 |
| 1699084871 | Spectrum Health Primary Care Partners | Allergy & Immunology | 4069 Lake Dr Se, Grand Rapids, MI 49546-8816 | 2010-10-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407313802 | Spectrum Health Hospitals | Clinic/Center | 4069 Lake Dr Se Ste 210, Grand Rapids, MI 49546-8816 | 2019-02-22 |
| 1275529562 | Spectrum Health Hospitals | Clinic/Center | 80 68th St Se, Grand Rapids, MI 49548-6980 | 2005-09-22 |
| 1366438632 | Spectrum Health Hospitals | Clinic/Center | 4100 Lake Dr Se, Grand Rapids, MI 49546-8292 | 2005-09-22 |
| 1720530405 | Grand Rapids Surgical Suites, Pllc | Clinic/Center | 2505 E Paris Ave Se, Suite 105, Grand Rapids, MI 49546-2459 | 2016-10-28 |
| 1134363690 | Oam Surgery Center At Midtowne, LLC | Clinic/Center | 555 Midtowne St Ne, Suite 200, Grand Rapids, MI 49503-5729 | 2009-04-28 |
| 1184815417 | Grand Rapids Plastic Surgery Plc | Clinic/Center | 426 Michigan St, Ste 300, Grand Rapids, MI 49503-5609 | 2007-08-01 |
| 1548332976 | Plastic Surgery Associates PC | Clinic/Center | 220 Lyon St Nw, Suite 700, Grand Rapids, MI 49503-2208 | 2006-11-14 |
| 1265487474 | Horseshoe Surgery Center, LLC | Clinic/Center | 1542 Golf Course Rd, Suite 105, Grand Rapids, MN 55744-9603 | 2006-05-24 |
| 1194798959 | East Paris Surgical Center, LLC | Clinic/Center | 1000 E Paris Ave Se, Suite Ll01, Grand Rapids, MI 49546-3680 | 2006-02-10 |
| 1255327540 | Spectrum Health Hospitals | Clinic/Center | 1000 E Paris Ave Se, Suite 100, Grand Rapids, MI 49546-3691 | 2005-09-22 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 49546 |
Please comment or provide details below to improve the information on SPECTRUM HEALTH.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.