ACADEMIC SURGICAL ASSOCIATES, PLLC — NPI 1114139045 (Licensed & Credentialed Allopathic & Osteopathic Physicians — Surgery

CMS-1500 Box 24J / 33a • NPI

1114139045

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

2086X0206X (CMS 02)

Licensed & Credentialed Allopathic & Osteopathic Physicians — Surgery — Surgical Oncology

Box 32 Service Location & ZIP+4

1000 E PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI, 49546-3691

✓ 9-Digit EDI 837 ZIP+4 (49546-3691)

Practice Phone & Referral Fax

(616) 977-6243

Fax: (616) 977-0396

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1114139045 (ACADEMIC SURGICAL ASSOCIATES, PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1114139045` (NPI-2 Organization / Facility)
Provider / Legal Name	ACADEMIC SURGICAL ASSOCIATES, PLLC
Plain-English Specialty	Licensed & Credentialed Allopathic & Osteopathic Physicians — Surgery — Surgical Oncology NUCC Code: `2086X0206X` (Surgery, Surgical Oncology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	1000 E PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI, 49546-3691
Practice Telephone / Fax	Tel: (616) 977-6243 \| Fax: (616) 977-0396
Administrative Mailing Address	1000 E PARIS AVE SE, GRAND RAPIDS, MI, 49546-3691
Enumeration & Last Sync	Enumerated: 2007-05-04 \| CMS Record Updated: 2007-08-06
Authorized Official	DAVID SCHEERES (president)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

1000 E PARIS AVE SE, SUITE 150, GRAND RAPIDS, MI, 49546-3691

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Plain-English Taxonomy & CMS Crosswalk (2086X0206X)

What Does Taxonomy Code 2086X0206X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2086X0206X translates to:
"Licensed & Credentialed Allopathic & Osteopathic Physicians — Surgery — Surgical Oncology"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 02 (Physician/General Surgery) • CMS Code 91 (Physician/Surgical Oncology)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Surgery, Surgical Oncology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (ACADEMIC SURGICAL ASSOCIATES, PLLC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2086X0206X` — Surgery, Surgical Oncology Plain English: Licensed & Credentialed Allopathic & Osteopathic Physicians — Surgery — Surgical Oncology	State: N/A \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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ACADEMIC SURGICAL ASSOCIATES, PLLC (NPI #1114139045)