NPIMap

Individual provider Active NPI

Gustavo F Tataje Rengifo, MD

  • Internal Medicine Physician
  • Lansing, MI
National Provider Identifier
1033601489
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
4301504688 Issued in MI
Practice address
3955 Patient Care Dr Ste a
Lansing, MI 48911
Phone
(517) 374-7600
NPI assigned
Jun 1, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 4351043487 MI
Internal Medicine Physician 207R00000X 4301504688 MI Primary

Addresses

Primary practice location

3955 Patient Care Dr Ste a
Lansing, MI 48911

Mailing address

3955 Patient Care Dr Ste a
Lansing, MI 48911-4271
Phone (517) 374-7600

Other practice location 1

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 593-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210727002539 MI Practitioner - Internal Medicine 8921401001 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Edward W Sparrow Hospital AssociationGroup PAC ID 6709799166, 698 clinicians

Practice addresses (Care Compare)

2446 Jolly Rd
Suite B
Okemos, MI 48864-3514
Phone (517) 253-5530

Hospital & facility affiliations

  • Elara Caring Home health agency, Jackson, MI, CCN 237274
  • Edward W Sparrow Hospital Hospital, Lansing, MI, CCN 230230
  • University of Michigan Health- Sparrow Clinton Hospital, Saint Johns, MI, CCN 231326
  • University of Michigan Health - Sparrow Eaton Hospital, Charlotte, MI, CCN 231327
  • Memorial Healthcare Hospital, Owosso, MI, CCN 230121

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4351043487MIMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Edward W Sparrow Hospital Association Internal Medicine CurrentSince Sep 24, 2023 Accepting new patients
Edward W Sparrow Hospital Association Internal Medicine CurrentSince Sep 24, 2023 Accepting new patients
Capital Internal Medicine Associates P.C. Internal Medicine CurrentSince Sep 1, 2021 Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Sep 24, 2023 Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

1500 S Main St
Eaton Rapids, MI 48827
Phone (517) 663-2671

3955 Patient Care Dr
Lansing, MI 48911
Phone (517) 374-7600

1215 E Michigan Ave
#8W
Lansing, MI 48912
Phone (517) 364-2614

1200 E Michigan Ave
Ste 500
Lansing, MI 48912
Phone (517) 364-5123

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

3955 Patient Care Dr
Ste A
Lansing, MI 48911
Phone (517) 374-7600

1200 E Michigan Ave
Ste 510
Lansing, MI 48912
Phone (517) 364-5184

230 Temple St
Mason, MI 48854
Phone (517) 676-4545

2446 Jolly Rd
Ste B
Okemos, MI 48864
Phone (517) 253-5530

Interoperability endpoints

  • Direct secure messaging: gtatajerengifo88785@sparrowdirecthie.org

Organizations & group practices 24

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.

View all 24

Hospital & facility affiliations 8

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": "1527811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626998400000",
    "number": "1033601489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3955 PATIENT CARE DR STE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489114271",
            "telephone_number": "517-374-7600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3955 PATIENT CARE DR STE A",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "48911",
            "telephone_number": "517-374-7600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18101 Oakwood Blvd",
            "address_purpose": "LOCATION",
            "city": "Dearborn",
            "state": "MI",
            "postal_code": "481244089",
            "country_code": "US",
            "telephone_number": "313-593-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TATAJE RENGIFO",
        "first_name": "GUSTAVO",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-01",
        "last_updated": "2021-07-23",
        "certification_date": "2021-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4351043487",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "4301504688",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.