Individual provider Active NPI

John Buell, PSYD

  • Clinical Psychologist
  • Grand Rapids, MI
National Provider Identifier
1063081495
Registry record updated Sep 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301019712 Issued in MI
Practice address
2118 3 Mile Rd NW
Grand Rapids, MI 49544-1425
Phone
(616) 222-3720
NPI assigned
Jun 21, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 4, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6351004751 MI
Clinical Psychologist 103TC0700X 6301019712 MI Primary

Addresses

Primary practice location

2118 3 Mile Rd NW
Grand Rapids, MI 49544-1425

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other practice location 1

300 68th St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other practice location 2

909 Sycamore St
Cincinnati, OH 45202-1305
Phone (513) 558-9006

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address PineRestCMHS@directaddress.pinerest.org Direct

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: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250915003788 MI Practitioner - Clinical Psychologist 4486158375 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2024
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

300 68TH St SE
Grand Rapids, MI 49548-6927

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6351004751MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services Psychologist CurrentSince Sep 4, 2025 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Sep 4, 2025 Accepting new patients

Locations

6500 Byron Center Ave SW
Ste 300
Byron Center, MI 49315
Phone (616) 281-6382

6500 Byron Center Ave SW
Byron Center, MI 49315
Phone (616) 281-6311

2118 3 Mile Rd NW
Walker, MI 49544
Phone (616) 222-3720

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

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": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1756944000000",
    "number": "1063081495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2118 3 MILE RD NW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495441425",
            "telephone_number": "616-222-3720"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "300 68th St SE",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495486927",
            "country_code": "US",
            "telephone_number": "616-455-5000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "909 Sycamore St",
            "address_purpose": "LOCATION",
            "city": "Cincinnati",
            "state": "OH",
            "postal_code": "452021305",
            "country_code": "US",
            "telephone_number": "513-558-9006",
            "fax_number": "513-558-3880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUELL",
        "first_name": "JOHN",
        "name_prefix": "Mr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-06-21",
        "last_updated": "2025-09-04",
        "certification_date": "2025-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6351004751",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301019712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PineRestCMHS@directaddress.pinerest.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "300 68th St SE",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495486927",
            "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.