NPIMap

Individual provider Active NPI

Phillip Gregory Wise, M.D.

  • Urology Physician
  • Grand Rapids, MI
National Provider Identifier
1124124086
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301078939 Issued in MI
Practice address
25 Michigan St NE
Suite 3300
Grand Rapids, MI 49503-2515
Phone
(616) 459-4171
Fax
(616) 459-0044
NPI assigned
Sep 16, 2006
Last updated
Jan 30, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 4301078939 MI Primary

Addresses

Primary practice location

25 Michigan St NE
Suite 3300
Grand Rapids, MI 49503-2515

Mailing address

20952 E 12 Mile Rd Ste 200
Saint Clair Shores, MI 48081-3203
Phone (586) 771-4820

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040709000826 MI Practitioner - Urology 8426036153 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Southern California Keck School of Medicine, 1982
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Michigan Institute of Urology PCGroup PAC ID 1052223492, 82 clinicians
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

25 Michigan St NE
Suite 3300
Grand Rapids, MI 49503-2558
Phone (616) 459-4171

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-7200

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301078939MIMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital Urology CurrentSince Nov 1, 2011 Accepting new patients
Alliance Physician Services of Michigan, P.C. Urology CurrentSince Nov 1, 2023 Accepting new patients
Alliance Physician Services of Michigan, P.C. Urology CurrentSince Aug 13, 2007 Accepting new patients
Metropolitan Hospital CurrentSince Nov 1, 2011 Accepting new patients
Michigan Institute of Urology PC Urology CurrentSince Nov 1, 2023 Accepting new patients

Locations

705 Oak St
Unit 6
Big Rapids, MI 49307
Phone (231) 796-2629

4150 S River Rd
Ste C
East China, MI 48054
Phone (576) 771-4820

21 Michigan St NE
Ste 750
Grand Rapids, MI 49503

25 Michigan St NE
Ste 3300
Grand Rapids, MI 49503
Phone 6164594171116

4070 Lake Dr SE
Ste L101
Grand Rapids, MI 49546
Phone (616) 301-7953

20952 E 12 Mile Rd
Ste 200
St Clr Shores, MI 48081
Phone (586) 771-4820

2093 Health Dr SW
Ste 202
Wyoming, MI 49519
Phone (586) 771-4820

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

781 36th St SE
Wyoming, MI 49548
Phone (616) 252-4100

Interoperability endpoints

  • Direct secure messaging: pwise25958@direct.metrohealth.net

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1124124086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20952 E 12 MILE RD STE 200",
            "city": "SAINT CLAIR SHORES",
            "state": "MI",
            "postal_code": "480813203",
            "telephone_number": "586-771-4820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 MICHIGAN ST NE",
            "address_2": "SUITE 3300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032515",
            "telephone_number": "616-459-4171",
            "fax_number": "616-459-0044"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISE",
        "first_name": "PHILLIP",
        "middle_name": "GREGORY",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-16",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301078939",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.