Source Medical Clinic in Grand Rapids, MI - Medicare General Practice

Source Medical Clinic is a medicare enrolled primary clinic (General Practice) in Grand Rapids, Michigan. The current practice location for Source Medical Clinic is 625 Kenmoor Ave Se Ste 301, Grand Rapids, Michigan. For appointments, you can reach them via phone at (616) 916-8063. The mailing address for Source Medical Clinic is 625 Kenmoor Ave Se Ste 301, Grand Rapids, Michigan and phone number is (616) 916-8063.

Source Medical Clinic is licensed to practice in * (Not Available) (license number ). The clinic also participates in the medicare program and its NPI number is 1326649120. This medical practice accepts medicare insurance (which means this clinic accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance). However, please confirm if they accept your insurance at (616) 916-8063.

Contact Information

	Source Medical Clinic
	625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395
	(616) 916-8063
	Not Available

Map and Direction

Primary Care Clinic Profile

Full Name	Source Medical Clinic
Speciality	General Practice
Location	625 Kenmoor Ave Se Ste 301, Grand Rapids, Michigan
Authorized Official Name and Position	Thomas Henke (OWNER/PHYSICIAN)
Authorized Official Contact	6169168063
Accepts Medicare Insurance	Yes. This clinic participates in medicare program and accept medicare insurance.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Source Medical Clinic 625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395 Ph: (616) 916-8063	Source Medical Clinic 625 Kenmoor Ave Se Ste 301 Grand Rapids MI 49546-2395 Ph: (616) 916-8063

NPI Details:

NPI Number	1326649120
Provider Enumeration Date	11/06/2020
Last Update Date	01/23/2022

Medicare PECOS Information:

Medicare PECOS PAC ID	4789095647
Medicare Enrollment ID	O20201124003305

Medical Identifiers

Medical identifiers for Source Medical Clinic such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1326649120	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208D00000X	General Practice	(* (Not Available))	Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Source Medical Clinic acts as a billing entity for following providers:

Provider Name	Thomas J Henke
Provider Type	Practitioner - General Practice
Provider Identifiers	NPI Number: 1922485515 PECOS PAC ID: 6800208364 Enrollment ID: I20201208000847

Reviews and Comments

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Source Medical Clinic - Medicare Primary Care in Grand Rapids, MI