NPIMap

Individual provider Active NPI

Courtney Ann Soubliere, DO

  • Endocrinology, Diabetes & Metabolism Physician
  • Grand Rapids, MI
National Provider Identifier
1275748121
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
5101015706 Issued in MI
Practice address
300 Lafayette SE
Ste 2045
Grand Rapids, MI 49503
Phone
(616) 685-3098
Fax
(616) 685-3095
NPI assigned
May 14, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 5101015706 MI Primary

Addresses

Primary practice location

300 Lafayette SE
Ste 2045
Grand Rapids, MI 49503

Mailing address

245 State St SE
Ste 228
Grand Rapids, MI 49503
Phone (616) 685-1808

Other names 1

  • Courtney Ann Castle Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address csoubliere25235@direct.trinity-health.org Direct

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
I20080723000755 MI Practitioner - EndocrinologyPractitioner - Internal Medicine 2264505205 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

300 Lafayette Ave SE
Suite 2045
Grand Rapids, MI 49503-4692
Phone (616) 685-3098

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary's Medical Group CurrentSince Aug 1, 2013 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Aug 1, 2013 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

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

245 State St SE
Ste 228
Grand Rapids, MI 49503

300 Lafayette Ave SE
Ste 2045
Grand Rapids, MI 49503
Phone (616) 685-3098

Interoperability endpoints

  • Direct secure messaging: csoubliere25235@direct.trinity-health.org

Organizations & group practices 3

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.

Hospital & facility affiliations 5

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": "1179100800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1275748121",
    "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",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE SE",
            "address_2": "STE 2045",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49503",
            "telephone_number": "616-685-3098",
            "fax_number": "616-685-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUBLIERE",
        "first_name": "COURTNEY",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-14",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "5101015706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "csoubliere25235@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "MercyOne North Iowa Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "300 Lafayette SE",
            "address_2": "Ste 2045",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49503",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "COURTNEY",
            "last_name": "CASTLE",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.