Gary Witucki, D.O.

Primary specialty

Undersea and Hyperbaric Medicine (Preventive Medicine) PhysicianTaxonomy code 2083P0011X

License

5101011763 Issued in MI

Practice address

1234 Napier Ave
Saint Joseph, MI 49085-2112

Phone

(269) 983-8601

NPI assigned

Feb 21, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Osteopathic Medicine, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeland Medical PracticesGroup PAC ID 1658427042, 286 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Corewell Health Lakeland Hospitals St Joseph Hospital Home health agency, Benton Harbor, MI, CCN 237163
• Mary Free Bed at Home, LLC Home health agency, Grand Rapids, MI, CCN 237203
• Lakeland Hospital, St Joseph Hospital, St Joseph, MI, CCN 230021

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: gwitucki1272742@epic00.corewelldirect.org

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

• Lakeland Medical Practices

  • Internal Medicine Physician
  • Saint Joseph, MI
  • NPI 1538397120
  Medicare reassignment Care Compare group NPD
• Lakeland Medical Practices

  • Internal Medicine Physician
  • Bridgman, MI
  • NPI 1568232247
  NPD
• Grand Valley Family Health Center

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1306062237
  NPD (past)
• Pennock Hospital

  • Rural Health Clinic/Center
  • Ionia, MI
  • NPI 1477940773
  NPD (past)
• Pennock Hospital

  • Family Medicine Physician
  • Hastings, MI
  • NPI 1518186295
  NPD (past)
• Commonwealth Specialists of Kentucky LLC

  • Pain Medicine Physician
  • Frankfort, KY
  • NPI 1770741498
  NPD (past)
• First Onsite, LLC

  • Family Medicine Physician
  • Richmond, VA
  • NPI 1649435538
  NPD (past)
• H2U Wellness Centers, LLC

  • Internal Medicine Physician
  • Nashville, TN
  • NPI 1649406687
  NPD (past)

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

• Lakeland Hospitals at Niles and St Joseph, Inc

  • General Acute Care Hospital
  • Saint Joseph, MI
  • NPI 1134220031
  Care Compare affiliation
• Lakeland Hospitals at Niles and St Joseph, Inc

  • Home Health Agency
  • Benton Harbor, MI
  • NPI 1912094525
  Care Compare affiliation
• Mary Free Bed at Home, LLC

  • Home Health Agency
  • Grand Rapids, MI
  • NPI 1023477478
  Care Compare affiliation

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

{
    "created_epoch": "1140480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1184699472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1234 NAPIER AVE",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490852112",
            "telephone_number": "269-983-8601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITUCKI",
        "first_name": "GARY",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-21",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "KY",
            "license": "03087",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "57339",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "WI",
            "license": "57339",
            "primary": false
        },
        {
            "code": "2083P0011X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Undersea and Hyperbaric Medicine",
            "state": "MI",
            "license": "5101011763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000601505",
            "state": "KY"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3300156",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100075950",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicholas C Wilson, DO
• Shelley Ann Wilson, D.D.S.
• Brianna Winkie
• Roy E Winslow, MD
• Jill Deanne Wise
• Gordon Sanghi Won, DDS
• Benjamin T. Wood
• Rafeek Olson Woods, M.D.
• Woodward Detroit CVS LLC
• Samantha Wright, RD

• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Undersea and Hyperbaric Medicine (Preventive Medicine) Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.