Individual provider Active NPI

Dominic Ondieki Abuya, FNP-BC

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1053984609
Registry record updated Dec 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704301890 Issued in MI
Practice address
145 Michigan St NE Ste 3410
Grand Rapids, MI 49503-2563
Phone
(616) 391-9945
NPI assigned
Jul 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704301890 MI Primary

Addresses

Primary practice location

145 Michigan St NE Ste 3410
Grand Rapids, MI 49503-2563

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dabuya176416@epic00.shdirect.org
FHIR URL https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/

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
I20210831002186 MI Practitioner - Nurse Practitioner 7517363575 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Theoria MedicalGroup PAC ID 5395098339, 317 clinicians
Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians

Practice addresses (Care Compare)

200 Roosevelt Ave E
Battle Creek, MI 49037-2829
Phone (248) 660-1220

850 Phillips St
South Haven, MI 49090-1845
Phone (269) 637-5147

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704301890MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Sep 1, 2021 Accepting new patients
Michigan Family Medicine and Urgent Care CurrentSince Nov 1, 2022 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Sep 1, 2021 Accepting new patients
Complexcare Medical Group Midwest H PLLC CurrentSince Jun 10, 2025 Accepting new patients

Locations

200 Roosevelt Ave E
Battle Creek, MI 49037
Phone (269) 965-3327

6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

145 Michigan St NE
Ste 3410
Grand Rapids, MI 49503
Phone (616) 391-9945

6531 W Michigan Ave
#C
Jackson, MI 49201
Phone (517) 750-3822

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763

850 Phillips St
South Haven, MI 49090
Phone (269) 637-5147

425 E Elm St
Wayland, MI 49348
Phone (269) 792-2249

Interoperability endpoints

  • Direct secure messaging: dabuya176416@epic00.corewelldirect.org
  • Direct secure messaging: dabuya176416@epic00.shdirect.org

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1626825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638489600000",
    "number": "1053984609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 MICHIGAN ST NE STE 3410",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032563",
            "telephone_number": "616-391-9945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABUYA",
        "first_name": "DOMINIC",
        "middle_name": "ONDIEKI",
        "name_prefix": "Mr.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-21",
        "last_updated": "2021-12-03",
        "certification_date": "2021-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704301890",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dabuya176416@epic00.shdirect.org",
            "affiliation": "N",
            "address_1": "145 Michigan St NE Ste 3410",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032563",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "145 Michigan St NE Ste 3410",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495032563",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.