Individual provider Active NPI

Edward Gonzales

  • Peer Specialist
  • Wyoming, MI
National Provider Identifier
1083445563
Registry record updated Dec 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
Practice address
950 36TH St SW
Wyoming, MI 49509-3587
Phone
(616) 336-8800
Fax
(616) 320-0406
NPI assigned
Aug 8, 2024
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X Primary

Addresses

Primary practice location

950 36TH St SW
Wyoming, MI 49509-3587

Mailing address

950 36TH St SW
Wyoming, MI 49509-3587
Phone (616) 336-8800

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

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

{
    "created_epoch": "1723075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765843200000",
    "number": "1083445563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "950 36TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495093587",
            "telephone_number": "616-336-8800",
            "fax_number": "616-320-0406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 36TH ST SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495093587",
            "telephone_number": "616-336-8800",
            "fax_number": "616-320-0406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONZALES",
        "first_name": "EDWARD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-08-08",
        "last_updated": "2025-12-16",
        "certification_date": "2025-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.