Individual provider Active NPI

Alberto Rivera Gutierrez, MD

  • Psychiatry Physician
  • Holland, MI
National Provider Identifier
1356394464
Registry record updated May 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
4301064703 Issued in MI
Practice address
926 S Washington Ave
Holland, MI 49423-7725
Phone
(616) 820-3780
NPI assigned
May 18, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 4301064703 MI Primary

Addresses

Primary practice location

926 S Washington Ave
Holland, MI 49423-7725

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Other identifiers 2

IdentifierTypeStateIssuer
4780142MedicaidMI
4780133MedicaidMI

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: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051017000219 MI Practitioner - Psychiatry 2769408053 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301064703MIMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services CurrentSince Sep 1, 2005 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Sep 1, 2005 Accepting new patients

Locations

926 Washington Ave
Ste 210
Holland, MI 49423
Phone (616) 820-3780

926 Washington Ave
Holland, MI 49423
Phone (616) 393-0166

1530 Nichols Rd
Kalamazoo, MI 49006
Phone (269) 343-6700

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369180800000",
    "number": "1356394464",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "926 S WASHINGTON AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237725",
            "telephone_number": "616-820-3780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA GUTIERREZ",
        "first_name": "ALBERTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-18",
        "last_updated": "2013-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301064703",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4780142",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4780133",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.