NPIMap

Individual provider Active NPI

Brian A Buckler, MD

  • Family Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1154344398
Registry record updated Sep 12, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301084540 Issued in MI
Practice address
1471 East Beltline
Ste 201
Grand Rapids, MI 49525
Phone
(616) 685-8620
Fax
(616) 447-7674
NPI assigned
Jul 26, 2006
Last updated
Sep 12, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301084540 MI Primary

Addresses

Primary practice location

1471 East Beltline
Ste 201
Grand Rapids, MI 49525

Mailing address

245 State St SE
Ste 228
Grand Rapids, MI 49503

Other identifiers 1

IdentifierTypeStateIssuer
381360529OtherMITAX ID

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
I20061004000270 MI Practitioner - Family Practice 7810993409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1471 E Beltline Ave NE
201 Trinity Health Med Group
Grand Rapids, MI 49525-4548
Phone (616) 685-8620

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301084540MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Primary Care Surgical PLLC Family Medicine Past Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients
Saint Mary's Health Services Past Accepting new patients
Trinity Health - Michigan Past Accepting new patients
Advantage Health Saint Mary's Medical Group Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

1471 E Beltline Ave NE
Ste 201
Grand Rapids, MI 49525
Phone (616) 685-3414

245 State St SE
Ste 1A
Grand Rapids, MI 49503

245 State St SE
Ste 228
Grand Rapids, MI 49503

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

Organizations & group practices 7

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 4

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": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1347408000000",
    "number": "1154344398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "address_2": "STE 228",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 EAST BELTLINE",
            "address_2": "STE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49525",
            "telephone_number": "616-685-8620",
            "fax_number": "616-447-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUCKLER",
        "first_name": "BRIAN",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301084540",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID",
            "identifier": "381360529",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.