EDWARD TANUDJAJA DO
NPI 1003499229
Internal Medicine in Muskegon, MI

Active since May 05, 2021PECOS EnrolledAccepts Medicare Assignment
1500 E SHERMAN BLVD, MUSKEGON, MI 49444(231) 672-2000 Get Directions Write a Review

NPPES record last updated: May 5, 2021. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Edward Tanudjaja Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDWARD TANUDJAJA DO (NPI 1003499229) is an individual internal medicine provider in Muskegon, Michigan, licensed in Michigan (5151015204) and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS and is a graduate of Arizona College Of Osteopathic Medicine Mid Western University (2021).

NPPES Registry Identity

NPI1003499229
Entity TypeIndividualMale
Primary Taxonomy207R00000X
Provider Legal NameEDWARD TANUDJAJACredential: DO
Location Address1500 E SHERMAN BLVDMuskegon, MI 49444-1849
Mailing Address18379 Woodland Ridge Dr Apt 6Spring Lake, MI 49456-8924 · (925) 437-8559
Sole ProprietorYes
Medical School CMSArizona College Of Osteopathic Medicine Mid Western UniversityGraduated 2021
Enumeration DateMay 5, 2021
NPPES CertifiedMay 5, 2021
NPI 1003499229 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
License Licensed in MI · 5151015204
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1500 E SHERMAN BLVD, Muskegon, MI 49444

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Edward Tanudjaja Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID2961941273
PECOS Enrollment IDI20240830001614
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 49444 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$126.15 typical visit price
range $54.34 – $166.68
Typical copayment $31.53 (range $13.58 – $41.67)
Most-billed visit code 99204
Established Patient
$96.44 typical visit price
range $17.09 – $135.40
Typical copayment $24.11 (range $4.27 – $33.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Hospitalist
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Student in an Organized Health Care Education/Training Program
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Emergency Medicine
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Pharmacist
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Pharmacist
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Hospitalist
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Anesthesiology
1500 E SHERMAN BLVD
MUSKEGON, MI 49444
Student in an Organized Health Care Education/Training Program
1500 E SHERMAN BLVD
MUSKEGON, MI 49444

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Edward Tanudjaja's NPI number?

The NPI number for Edward Tanudjaja is 1003499229. It was assigned to this individual provider in the NPPES registry on May 5, 2021.

Where is Edward Tanudjaja located?

Edward Tanudjaja practices at 1500 E Sherman Blvd, Muskegon, MI 49444. The listed phone number is (231) 672-2000.

What is Edward Tanudjaja's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Edward Tanudjaja enrolled in Medicare?

Yes. Edward Tanudjaja is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

When was this NPI record last updated?

The NPPES record for Edward Tanudjaja was last updated on May 5, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.