Individual provider Active NPI

Trevor Chuangkuo Wu, PHD

  • Clinical Psychologist
  • Grand Rapids, MI
National Provider Identifier
1346652492
Registry record updated Feb 4, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301015974 Issued in MI
Practice address
220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone
(616) 685-5050
Fax
(616) 685-8962
NPI assigned
May 23, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 4, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301015974 MI
Clinical Neuropsychologist 103G00000X
Clinical Psychologist 103TC0700X 6301015974 MI Primary

Addresses

Primary practice location

220 Cherry St SE
Grand Rapids, MI 49503-4608

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008

Other names 1

  • Chuangkuo Wu Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140715000086 MI Practitioner - Clinical Psychologist 0840415543 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Practice addresses (Care Compare)

220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
6301015974MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Aug 1, 2014 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Aug 1, 2014 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

220 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 685-5576

245 Cherry St SE
Ste 104
Grand Rapids, MI 49503
Phone (616) 774-6337

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

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 1

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": "1400803200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1770163200000",
    "number": "1346652492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034608",
            "telephone_number": "616-685-5050",
            "fax_number": "616-685-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WU",
        "first_name": "TREVOR",
        "middle_name": "CHUANGKUO",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-05-23",
        "last_updated": "2026-02-04",
        "certification_date": "2026-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301015974",
            "primary": false
        },
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301015974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHUANGKUO",
            "last_name": "WU",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.