INTERNAL MEDICINE AND PEDIATRICS OF WEST MICHIGAN
NPI 1104170661
Internal Medicine in Grand Rapids, MI

Q: What is Internal Medicine And Pediatrics Of West Michigan's specialty?

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

Active since November 06, 2012CLIA 23D2049759 · Waiver

655 KENMOOR AVE SE, SUITE 200, GRAND RAPIDS, MI 49546(616) 363-7690(616) 942-8917 Get Directions Write a Review

NPPES record last updated: April 15, 2024. Verified against the NPPES registry weekly; last sync: October 25, 2026.

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About Internal Medicine And Pediatrics Of West Michigan NPPES

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

INTERNAL MEDICINE AND PEDIATRICS OF WEST MICHIGAN (NPI 1104170661) is a healthcare organization registered as an internal medicine in Grand Rapids, Michigan and active in the NPI registry since November 2012. The organization holds a CLIA Waiver certificate valid through November 13, 2026 and lists Deanna Rawlings, Office Manager, as its authorized official.

NPPES Registry Identity

NPI1104170661

Entity TypeOrganization

Primary Taxonomy207R00000X

Legal Business NameINTERNAL MEDICINE AND PEDIATRICS OF WEST MICHIGAN

Location Address655 KENMOOR AVE SE, SUITE 200Grand Rapids, MI 49546

Mailing Address655 Kenmoor Ave Se, Suite 200Grand Rapids, MI 49546 · (616) 363-7690 · Fax (616) 942-8917

Phone(616) 363-7690

Fax(616) 942-8917

Organization SubpartNo

Authorized OfficialDeanna RawlingsOffice Manager · (616) 323-3227

Enumeration DateNovember 6, 2012

Last NPPES UpdateApril 15, 2024

✔ NPI 1104170661 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 · 4301071009

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.

655 KENMOOR AVE SE, Grand Rapids, MI 49546

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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Internal Medicine And Pediatrics Of West Michigan is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by January 31, 2027

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date

StateMichiganEnrollment IDO20130215000130Non-DME Part B · Clinic/Group PracticeDue dateJanuary 31, 2027

Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 9 clinicians reassign Medicare billing to Internal Medicine And Pediatrics Of West Michigan, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 8 within 10 miles. They are listed nearest first.