NPIMap

Organization Active NPI

Meridian Wellness, PLLC

  • Family Medicine Physician
  • Okemos, MI
National Provider Identifier
1124631445
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MERIDIAN WELLNESS, PLLC
Practice address
2422 Jolly Rd Ste 100
Okemos, MI 48864-3690
Phone
(517) 618-9507
NPI assigned
Aug 26, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Authorized official

Name
Mrs. Michelle Gormas, PA-CNPI 1144479148
Title
Manager
Phone
(517) 618-9507

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

2422 Jolly Rd Ste 100
Okemos, MI 48864-3690

Mailing address

2422 Jolly Rd Ste 100
Okemos, MI 48864-3690
Phone (517) 618-9507

Other names 1

  • Avenue Health Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Other URL connect@avehealth.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201124001683 MI Part B Supplier - Clinic/Group Practice 9335550375 Receives reassigned benefits from 5 practitioners
Practice locations: Okemos, MI

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2210185Meridian Wellness, PLLC2422 Jolly Road, Suite 100, Okemos, MI 48864Certificate of waiverJan 19, 2027

National Provider Directory

National Provider Directory

Locations

2722 E Michigan Ave
Ste 103
Lansing, MI 48912
Phone (517) 400-4606

2722 E Michigan Ave
Lansing, MI 48912

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1598400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631836800000",
    "number": "1124631445",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2422 JOLLY RD STE 100",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643690",
            "telephone_number": "517-618-9507"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 JOLLY RD STE 100",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488643690",
            "telephone_number": "517-618-9507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MERIDIAN WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-26",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A",
        "authorized_official_last_name": "GORMAS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "517-618-9507",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "connect@avehealth.org",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "email",
            "address_1": "2422 Jolly Rd Ste 100",
            "city": "Okemos",
            "state": "MI",
            "country_code": "US",
            "postal_code": "488643690",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Avenue Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Okemos, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.