Saint Mary'S Health Services
Organization Active NPI Anesthesiology Physician · Grand Rapids, MI
NPI 1124063078 · NPPES record last updated Jan 30, 2023
Key facts
- NPI
- 1124063078
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- SAINT MARY'S HEALTH SERVICES
- Practice address
- 200 Jefferson Ave SE
Grand Rapids, MI 49503-4502 - Phone
- (616) 732-8956
- NPI assigned
- Jun 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Michael Gusho
- Title
- Cfo, Treasurer
- Phone
- (734) 398-0642
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 3
Corporate family (same tax ID) 8
Member of 1
Practitioners 223
-
Kristen Boersema, CRNA
-
Jessica Carlson, CRNA
-
Mark Allen Cook, DO
-
Andrew Cooper, CRNA
-
Jenna Ann Cozzolino, CRNA
-
Jennifer Nicole Dykstra, CRNA
-
Krista Joy Good, CRNA
-
Kenneth Hayes, M.D.
-
Sara Hoover, CRNA
-
Sallu Jabati, MD
-
Hannah Jaiven, DNP/CRNA
-
Alyssa Jane Jelsema, CRNA
-
Tammie Ann Keane, CRNA
-
Alyssa Kerndt, RN
-
Tyler Kleaveland, MD
-
Rebecca Sue Kremsreiter, CRNA
-
Lindsay Ann Mason, CRNA
-
Philip Muellerleile, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Holland Home - Raybrook Manor |
Skilled nursing facility | Adp of the SNF | Jan 1, 2000 |
| Holland Home-Breton Rehabilitation & Living Centre |
Skilled nursing facility | Adp of the SNF | Jan 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040329001233 | MI | Part B Supplier - Clinic/Group Practice | 4981500436 |
Receives reassigned benefits from 196 practitioners Practice locations: Grand Rapids, MI |
National Provider Directory
- Tax ID family
- Saint Marys McAuley Cli
Locations
1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes | ||
| Certified Registered Nurse Anesthetist |
367500000X |
Addresses
Primary practice location
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Mailing address
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000
Other providers in Grand Rapids, MI
- Carl Ben Sain Jr.
- Sandeep Sainathan
- Morgan Sainsbury
- Saint Mary'S Amicare Home Healthcare
- Saint Mary'S Health Services
- Saint Mary'S Health Services
- Saint Mary'S Health Services
- Saint Mary'S Health Services
- Saint Mary'S Health Services
- Saint Mary'S Hospital
All providers in Grand Rapids, MI · Anesthesiology Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.