SPECTRUM HEALTH- LAKE DRIVE SURGERY CENTER
NPI 1811983000
Clinic/Center - Ambulatory Surgical in Grand Rapids, MI
NPI Status: Active since September 22, 2005
Contact Information
4069 LAKE DR SE
SUITE 210
GRAND RAPIDS, MI
ZIP 49546
Phone: (616) 285-1120
- Organization
- Clinic/Center
- Ambulatory Surgical
- CLIA Number: 23D1033113
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 02-15-2027
About SPECTRUM HEALTH- LAKE DRIVE SURGERY CENTER
This page provides the complete NPI Profile along with additional information for Spectrum Health- Lake Drive Surgery Center, a provider established in Grand Rapids, Michigan operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1811983000 assigned on September 2005. The practitioner's primary taxonomy code is 261QA1903X with license number 416835 (MI). The provider is registered as an organization and their NPI record was last updated 12 years ago. The provider's is doing business as Spectrum Health- Lake Drive Surgery Center. The authorized official of this NPI record is Mr. Dougals D Welday (Vp Finance)
- NPI
- 1811983000
- Provider Legal Name
- SPECTRUM HEALTH
- Other Organization Name
- SPECTRUM HEALTH- LAKE DRIVE SURGERY CENTER
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 4069 LAKE DR SE SUITE 210 GRAND RAPIDS, MI 49546
- Location Phone
- (616) 285-1120
- Mailing Address
- 100 MICHIGAN ST NE MC 406 GRAND RAPIDS, MI 49503
- Mailing Phone
- (616) 391-1774
- Mailing Fax
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- Yes
- Enumeration Date
- 09-22-2005
- Last Update Date
- 07-29-2014
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
- License No.
- 416835
- License State
- MI
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 332B00000X | Suppliers | Durable Medical Equipment & Medical Supplies |
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| 5170255 | MEDICAID (05) | MI | |
| 230038 | MEDICARE PIN (08) | MI | |
| 41034 | OTHER (01) | MI | BLUE CROSS |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D1033113
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- February 16, 2025
- Certificate Expiration Date
- February 15, 2027
- Laboratory Director
- KENNETH D. MINKS
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Spectrum Health- Lake Drive Surgery Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1811983000, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 60. The final step is to find the difference between that total and the next multiple of ten (60 - 60 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 60 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 20 providers are registered at the same or a nearby location.
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
GRAND RAPIDS, MI 49546
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1811983000, enumerated as an "organization" on September 22, 2005.
The provider is located at 4069 LAKE DR SE SUITE 210 GRAND RAPIDS, MI 49546 and the phone number is (616) 285-1120.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Medicare, Medicaid and Blue Cross Blue Shield. Please consult your insurance carrier or call the provider to verify.
