Active NPI
Sera A Gruszka, PHD, LP
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1093943359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 6301014846
- Practice address
- 1400 Leonard St NE
Grand Rapids, MI 49505-5515 - Phone
- (616) 325-5144
- NPI assigned
- Jun 25, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301014846 | MI | Primary |
| Psychologist | 103T00000X | 6301014195 | MI |
Addresses
Primary practice location
1400 Leonard St NE
Grand Rapids, MI 49505-5515
Mailing address
1400 Leonard St NE
Grand Rapids, MI 49505-5515
Phone (616) 325-5144
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2026 through Jan 1, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301014195 | MI | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1245888000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1721952000000",
"number": "1093943359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1400 LEONARD ST NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055515",
"telephone_number": "616-325-5144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1400 LEONARD ST NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495055515",
"telephone_number": "616-325-5144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRUSZKA",
"first_name": "SERA",
"middle_name": "A",
"credential": "PHD, LP",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-06-25",
"last_updated": "2024-07-26",
"certification_date": "2024-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301014846",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301014195",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.