Individual provider Active NPI

Gavin O'Brien

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1003689183
Registry record updated Apr 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
770 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-8602
Phone
(616) 272-3533
Fax
(616) 259-4839
NPI assigned
Nov 1, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 7, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X MI Primary

Addresses

Primary practice location

770 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-8602

Mailing address

801 Rosehill Rd
Jackson, MI 49202-1762
Phone (517) 212-2008

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260327002147 MI Practitioner - Physician Assistant 8820573843 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northview Medical House Calls PLCGroup PAC ID 9537345400, 36 clinicians
Northview Health Specialists, PLLCGroup PAC ID 9638422835, 24 clinicians

Practice addresses (Care Compare)

4760 Fashion Square Blvd
Suite L 1
Saginaw, MI 48604-2620
Phone (989) 282-4003

770 Kenmoor Ave SE
Suite 100
Grand Rapids, MI 49546-8602
Phone (616) 272-3533

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northview Medical House Calls PLC CurrentSince Mar 19, 2026 Accepting new patients
Careline Hmi300 LLC CurrentSince Mar 19, 2026 Accepting new patients
Northview Health Specialists, PLLC CurrentSince Mar 19, 2026 Accepting new patients
Premier Heart Associates, Inc PastSince Mar 19, 2026 Accepting new patients

Locations

770 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 272-3533

801 Rosehill Rd
Jackson, MI 49202
Phone (517) 212-2008

4760 Fashion Square Blvd
Ste L1
Saginaw, MI 48604
Phone (989) 282-4003

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1698796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775520000000",
    "number": "1003689183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 ROSEHILL RD",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492021762",
            "telephone_number": "517-212-2008",
            "fax_number": "517-212-9023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "770 KENMOOR AVE SE STE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468602",
            "telephone_number": "616-272-3533",
            "fax_number": "616-259-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'BRIEN",
        "first_name": "GAVIN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-11-01",
        "last_updated": "2026-04-07",
        "certification_date": "2026-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.