Address Healthcare of Michigan PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

ADDRESS HEALTHCARE OF MICHIGAN PLLC

Practice address

600 Monroe Avenue NW
Ste 104
Grand Rapids, MI 49503-1470

Phone

(616) 366-4234

Fax

(855) 548-4481

NPI assigned

Feb 16, 2024

Organization subpart

No

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

Authorized official

Name

Jeffrey L Wacksman

Title

Authorized Official

Phone

(616) 366-4234

Specialties & licenses 6

Addresses

Other names 2

• Address Healthcare Doing business as
• Address Healthcare of Michigan Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Hilary Joy Cooper, FNP-C

  • Family Nurse Practitioner
  • Byron Center, MI
  • NPI 1710469366
  Medicare reassignment NPD
• Christi Ganner Gagliano, APRN

  • Family Nurse Practitioner
  • New Port Richey, FL
  • NPI 1205884269

  MI

  Medicare reassignment NPD
• Peter Arthur Radice, M.D.

  • Hospice and Palliative Medicine (Internal Medicine) Physician
  • New Port Richey, FL
  • NPI 1356339170

  MI

  Medicare reassignment NPD
• Adriana Smith, ARNP

  • Family Nurse Practitioner
  • New Port Richey, FL
  • NPI 1528561081

  MI

  Medicare reassignment NPD
• Christopher A Morrison, MD

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1134150501
  NPD (past)

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

{
    "created_epoch": "1708041600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1746403200000",
    "number": "1043075294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3940 PENINSULAR DRIVE SE",
            "address_2": "STE 230",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462442",
            "telephone_number": "616-366-4234",
            "fax_number": "855-548-4481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 MONROE AVENUE NW",
            "address_2": "STE 104",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031470",
            "telephone_number": "616-366-4234",
            "fax_number": "855-548-4481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDRESS HEALTHCARE OF MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-02-16",
        "last_updated": "2025-05-05",
        "certification_date": "2025-04-18",
        "status": "A",
        "authorized_official_last_name": "WACKSMAN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "616-366-4234"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RH0002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "213ES0103X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Address Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Address Healthcare",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Address Healthcare of Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Stephanie Adams
• Terri M Adams, RN
• Megan Adamski
• Dane Michael Addington, MSW
• Emily Jane Addington, PA-C
• Akuorkor A Addy, M.D.
• Adelante Counseling LLC
• Melinda Ann Adema, PTA
• Olusanjo Olaoluwa Adeoye, MD, MBA
• Olivia Rachel Adgate, CTRS

• Internal Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.