NPIMap

Organization Active NPI

Great Lakes Neurosurgical Associates, PC

  • Durable Medical Equipment & Medical Supplies
  • Grand Rapids, MI
National Provider Identifier
1306366810
Registry record updated Feb 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
GREAT LAKES NEUROSURGICAL ASSOCIATES, PC
Practice address
3350 Eagle Park Dr NE Ste 102
Grand Rapids, MI 49525-4570
Phone
(616) 454-3465
Fax
(616) 454-9004
NPI assigned
Jun 26, 2017
Last updated
Feb 24, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 24, 2025

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

Authorized official

Name
Lisa Santos
Title
Executive Director
Phone
(616) 242-7042

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU Primary

Addresses

Primary practice location

3350 Eagle Park Dr NE Ste 102
Grand Rapids, MI 49525-4570

Mailing address

3350 Eagle Park Dr NE Ste 102
Grand Rapids, MI 49525-4570
Phone (616) 454-3465

Other identifiers 2

IdentifierTypeStateIssuer
0D11057OtherMIBLUE CROSS AND BLUE SHIELD OF MICHIGAN
1366590929MedicaidMI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 39

NPI Registry JSON

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

{
    "created_epoch": "1498435200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740355200000",
    "number": "1306366810",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3350 EAGLE PARK DR NE STE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495254570",
            "telephone_number": "616-454-3465",
            "fax_number": "616-454-9004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3350 EAGLE PARK DR NE STE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495254570",
            "telephone_number": "616-454-3465",
            "fax_number": "616-454-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES NEUROSURGICAL ASSOCIATES, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-26",
        "last_updated": "2025-02-24",
        "certification_date": "2025-02-24",
        "status": "A",
        "authorized_official_last_name": "SANTOS",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "616-242-7042"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS AND BLUE SHIELD OF MICHIGAN",
            "identifier": "0D11057",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366590929",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.