Grand River Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GRAND RIVER SURGERY CENTER, LLC

Practice address

1090 Trowbridge Rd Ste a
East Lansing, MI 48823-5220

Phone

(517) 220-0240

Fax

(517) 200-4455

NPI assigned

Mar 26, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Douglas Dietzel, DO

Title

Ceo

Phone

(517) 488-8800

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Listed as

Grand River Surgery Center LLCCCN 23C0001151

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1124605910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1090 TROWBRIDGE RD STE A",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235220",
            "telephone_number": "517-282-0851"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1090 TROWBRIDGE RD STE A",
            "city": "EAST LANSING",
            "state": "MI",
            "postal_code": "488235220",
            "telephone_number": "517-220-0240",
            "fax_number": "517-200-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND RIVER SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-26",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "DIETZEL",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "517-488-8800",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grace Counseling
• Grace Therapy PLLC
• Graceful Hands Doula Care, LLC
• Kellie Grady, LPC
• Ketura Blondelle Lauture Graham
• Alex Lee Grand
• Taylor Lee Grantham
• Grassroots Groundwork L.L.C.
• Great Lakes Caring Home Health C Mi, LLC
• Great Lakes Caring Hospice C Mi, LLC

• Ambulatory Surgical Clinic/Center in East Lansing, MI
• Providers in East Lansing, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.