DR. KELLY ANNE WATERS (NPI# 1821232455) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821232455 |
| Entity Type | Individual |
| Full Name | DR. KELLY ANNE WATERS |
| Credential | M.D. |
| Practice Address |
4100 Lake Dr Se Ste 200 Grand Rapids MI 49546-8292 |
| Mailing Address |
100 Michigan St Ne Mc 845 Grand Rapids MI 49503-2560 |
| Practice Telephone | 6163913759 |
| Practice Fax Number | 6163913052 |
| Enumeration Date | 2009-04-27 |
| Last Update Date | 2017-08-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RS0012X |
Internal Medicine Specialization: Sleep Medicine |
4301104008 | MI | Allopathic & Osteopathic Physicians |
| N | 2084S0012X |
Psychiatry & Neurology Specialization: Sleep Medicine |
4301104008 | MI | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093273542 | Kelly Miranda Waters | Counselor | 2701 17th St, Rock Island, IL 61201-5351 | 2019-03-04 |
| 1841502366 | Kelly J Waters | Social Worker | 1503 Santa Rosa Rd, Suite 211, Richmond, VA 23229-5105 | 2010-07-13 |
| Street Address |
4100 LAKE DR SE STE 200 |
| City | GRAND RAPIDS |
| State | MI |
| Zip Code | 49546-8292 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477548832 | Robert A Burghduf Jr. | Physician Assistant | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2005-09-13 |
| 1023648912 | Breanne Renae Cook | Nurse Practitioner | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2020-01-21 |
| 1588204598 | Sarah Elizabeth Knoll | Nurse Practitioner | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2020-01-08 |
| 1710450259 | Bridget Leigh Schafer | Nurse Practitioner | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2019-01-08 |
| 1043797830 | Janiece Ann Feuerstein | Nurse Practitioner | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2018-07-24 |
| 1457837460 | Alyssa Shea Caminata | Nurse Practitioner | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2018-07-12 |
| 1326577404 | Caitlin Megan Greene | Physician Assistant | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2017-06-12 |
| 1881138220 | Courtney Golding | Psychologist | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2016-12-05 |
| 1194178178 | Ravi Kanth Velagapudi | Internal Medicine | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2016-07-14 |
| 1942652961 | Disha Geriani | Internal Medicine | 4100 Lake Dr Se Ste 200, Grand Rapids, MI 49546-8292 | 2016-07-02 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437762986 | Amanda Mae Ostrom | Speech-Language Pathologist | 710 Kenmore Ave Se, #110, Grand Rapids, MI 49546 | 2020-08-25 |
| 1063075562 | Kelly Lynn Ibarra | Counselor | 4467 Cascade Road Se, Suite #4479, Grand Rapids, MI 49546 | 2019-04-19 |
| 1891257036 | Jessica Matthews LLC | Counselor | 4127 Embassy Drive Se, Grand Rapids, MI 49546 | 2019-04-05 |
| 1326518531 | Neah Morgan | Technician | 4220 Burton St Se, Grand Rapids, MI 49546 | 2018-11-29 |
| 1316430267 | Michael John Benskey | Case Manager/Care Coordinator | 4065 Saladin St Se, Grand Rapids, MI 49546 | 2018-06-14 |
| 1679062772 | Smile Cascade, P.C. | Clinic/Center | 4505 Cascade Rd Se # A, Grand Rapids, MI 49546 | 2018-05-03 |
| 1720583289 | Jeromy Krogman | Counselor | 826 Parchment Drive Se, Grand Rapids, MI 49546 | 2018-03-27 |
| 1841792660 | Affordable Hearing Clinic | Hearing Instrument Specialist | 833 Kenmoor Ave Se Ste G, Grand Rapids, MI 49546 | 2018-03-07 |
| 1689176133 | Kelly Pines | Physical Therapist | 625 Kenmoor Ave Suite 306, Grand Rapids, MI 49546 | 2018-03-01 |
| 1467971440 | Deanna Elizabeth Saenz | Social Worker | 2100 Raybrook St Se Ste 300, Grand Rapids, MI 49546 | 2017-09-12 |
| Find all providers in zip 49546 | ||||
| Taxonomy Code | 207RS0012X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Sleep Medicine |
| An Internist who practices Sleep Medicine is certified in the subspecialty of sleep medicine and specializes in the clinical assessment, physiologic testing, diagnosis, management and prevention of sleep and circadian rhythm disorders. Sleep specialists treat patients of any age and use multidisciplinary approaches. Disorders managed by sleep specialists include, but are not limited to, sleep related breathing disorders, insomnia, hypersomnias, circadian rhythm sleep disorders, parasomnias and sleep related movement disorders. |
| Notes: Source: American Academy of Sleep Medicine, www.aasm.org [7/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962660092 | Michigan Medical Patient Care | Internal Medicine | 260 Jefferson Ave Se, Grand Rapids, MI 49503-4597 | 2008-05-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144796913 | Internal Medicine Sleep Associates Pllc | Internal Medicine | 7300 Deep Run, Bloomfield Hills, MI 48301-3821 | 2018-10-19 |
| 1457739534 | Comprehensive Sleep Diagnostics | Internal Medicine | 3515 Coolidge Rd Ste A, East Lansing, MI 48823-8014 | 2015-05-11 |
| 1588078901 | Aairs Diagnostics PC | Internal Medicine | 1500 W. Big Beaver, Ste 107, Troy, MI 48084 | 2014-06-13 |
| 1184042723 | Harrison M Gimbel | Internal Medicine | 1500 E Medical Center Dr Spc 5316, Ann Arbor, MI 48109 | 2014-04-01 |
| 1295906741 | Great Lakes Sleep Medicine Institute Plc | Internal Medicine | 3058 Metropolitan Parkway, Suite 108, Sterling Heights, MI 48310 | 2008-03-12 |
| 1124220140 | Todd C Gould Do Oc | Internal Medicine | 305 Barclay Cir, Suite 1000, Rochester Hills, MI 48307-4572 | 2007-06-01 |
| 1306969944 | Ruth Darcel Barnett | Internal Medicine | 15121 W Mcnichols Rd, Detroit, MI 48235-3716 | 2007-04-09 |
| 1255455887 | Margaret Moen Md Pllc | Internal Medicine | 457 Munson Ave, Traverse City, MI 49686-3084 | 2007-03-19 |
| 1578634440 | Sleep Apnea Specialty Centers Of | Internal Medicine | 42180 Ford Rd, Suite 201, Canton, MI 48187-3673 | 2006-11-13 |
| 1801966080 | Sleep Apnea Specialty Center | Internal Medicine | 14031 Pennsylvania Rd, Suite A, Riverview, MI 48193-7508 | 2006-11-08 |
| Find all providers with the same taxonomy | ||||
| City | GRAND RAPIDS |
| Zip Code | 49546 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.