West Michigan Dermatology – Dermatology Physician, NPI 1609896034
Dermatology Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for West Michigan Dermatology
4175 PARKWAY PLACE DR SW STE 104
GRANDVILLE, MI 494182382
Phone: (616) 257-3344
Fax: (616) 257-1491
Type: Mailing
3290 N Wellness Dr Ste 240
Holland, MI 494247261
Phone: (616) 395-9379
Fax: (616) 820-1457
Type: Location
6150 Northland Drive
Rockford, MI 49341
Phone: (616) 942-9343
Fax: (616) 942-2538
Type: Location
3434 RIVERTOWN POINT CT SW
GRANDVILLE, MI 494183076
Phone: (616) 257-3344
Fax: (616) 257-1491
Type: Mailing
100, 44th Street Southwest, Wyoming, Kent County, Michigan, 49548, United States
WYOMING, MI 495196836
Phone: (616) 257-3344
Fax: (616) 257-1491
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-08-06
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2023-10-31 (953 days ago).
Enrollment records
2
Earliest due date
2023-10-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040417000443 | O | Clinic/Group Practice | MI | 2023-12-31 |
| O20040806001261 | O | Clinic/Group Practice | MI | 2023-10-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 49418)
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