12TH STREET INTERNAL MEDICINE AND PEDIATRICS
NPI 1790470409
Internal Medicine in Wayland, MI
About 12th Street Internal Medicine And Pediatrics NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
12TH STREET INTERNAL MEDICINE AND PEDIATRICS (NPI 1790470409) is a healthcare organization registered as an internal medicine in Wayland, Michigan and active in the NPI registry since April 2023. The organization holds a CLIA Waiver certificate valid through June 11, 2027 and lists Joel Veldhouse, Physician Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 2
Other Names 1
Group Practice 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
12th Street Internal Medicine And Pediatrics is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
3Medicare enrollment records show 3 clinicians reassign Medicare billing to 12th Street Internal Medicine And Pediatrics, which bills Medicare for the services they deliver. Of these, 1 practice at this address. They are listed nearest first.
Clinicians, nearest first (3)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 23D2283672
12th Street Internal Medicine And Pediatrics · Wayland, MIFrequently 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 12th Street PLLC's NPI number?
The NPI number for 12th Street PLLC is 1790470409. It was assigned to this organization in the NPPES registry on April 7, 2023. The provider is doing business as 12th Street Internal Medicine And Pediatrics.
Where is 12th Street PLLC located?
12th Street PLLC is located at 3587 12th St, Wayland, MI 49348. The listed phone number is (616) 648-4933.
What is 12th Street PLLC's specialty?
The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.
Is 12th Street PLLC enrolled in Medicare?
Yes. 12th Street PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through 12th Street PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 3 clinicians reassign their Medicare billing to 12th Street PLLC, in Internal Medicine and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 1 practice at this address. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Does 12th Street PLLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 23D2283672) is associated with this NPI, valid through June 11, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
What insurance does 12th Street PLLC accept?
Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list 12th Street PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for 12th Street PLLC was last updated on August 15, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 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.
# 12th Street Internal Medicine And Pediatrics · NPI 1790470409
Internal Medicine organization in Wayland, Michigan. Organization record, active in the CMS NPPES registry since April 7, 2023.
## Identity
- **NPI:** 1790470409 (Entity type: Organization)
- **Enumerated:** April 7, 2023
- **Primary specialty:** Internal Medicine · taxonomy 207R00000X
- **Legal business name:** 12th Street Pllc
- **Organization subpart:** No
- **Authorized official:** Joel Veldhouse, PHYSICIAN OWNER
## Practice location
- **Address:** 3587 12TH ST, Wayland, MI 49348-9569
- **Phone:** (616) 648-4933
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 3 clinicians in 2 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Internal Medicine (2), Nurse Practitioner (1); 1 practice at this address · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 15, 2023
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1790470409) · Data from the CMS NPPES public registry.