David Tetsuji Ishiyama, MD - Medicare Emergency Medicine in Grand Rapids, MI

David Tetsuji Ishiyama, MD is a medicare enrolled "Emergency Medicine" physician in Grand Rapids, Michigan. He went to Michigan State University College Of Human Medicine and graduated in 2010 and has 14 years of diverse experience with area of expertise as Emergency Medicine. He is a member of the group practice Independent Observation Physicians Pllc and his current practice location is 1000 Monroe Ave Nw, Grmep, Grand Rapids, Michigan. You can reach out to his office (for appointments etc.) via phone at (616) 391-8879.

David Tetsuji Ishiyama is licensed to practice in Michigan (license number 4301096372) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1407177884.

Contact Information

David Tetsuji Ishiyama, MD
1000 Monroe Ave Nw, Grmep,
Grand Rapids, MI 49503-1455
(616) 391-8879
Not Available

Map and Direction




Physician's Profile

Full NameDavid Tetsuji Ishiyama
GenderMale
SpecialityEmergency Medicine
Experience14 Years
Location1000 Monroe Ave Nw, Grand Rapids, Michigan
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • David Tetsuji Ishiyama attended and graduated from Michigan State University College Of Human Medicine in 2010
  NPI Data:
  • NPI Number: 1407177884
  • Provider Enumeration Date: 06/19/2010
  • Last Update Date: 05/31/2013
  Medicare PECOS Information:
  • PECOS PAC ID: 6800037193
  • Enrollment ID: I20130730000120

Medical Identifiers

Medical identifiers for David Tetsuji Ishiyama such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1407177884NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207P00000XEmergency Medicine 4301096372 (Michigan)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Henry Ford Allegiance HealthJackson, MIHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Independent Observation Physicians Pllc357760360474

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. David Tetsuji Ishiyama allows following entities to bill medicare on his behalf.
Entity NameIndependent Emergency Physicians, P.c.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1780791343
PECOS PAC ID: 6709798325
Enrollment ID: O20031103000407
Entity NameW.a. Foote Memorial Hospital, Inc.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1265487722
PECOS PAC ID: 0244136067
Enrollment ID: O20031215000808
Entity NameIndependent Observation Physicians Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700119500
PECOS PAC ID: 3577603604
Enrollment ID: O20091221000327

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. David Tetsuji Ishiyama is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
David Tetsuji Ishiyama, MD
44650 Danbury Rd,
Canton, MI 48188-1050

Ph: () -
David Tetsuji Ishiyama, MD
1000 Monroe Ave Nw, Grmep,
Grand Rapids, MI 49503-1455

Ph: (616) 391-8879

Reviews and Comments


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Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.