Active NPI
Gary L Marsiglia, D.O.
- Family Medicine Physician
- Grand Rapids, MI
National Provider Identifier
1487618666
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 5101007137
- Practice address
- 1471 Grace St SE
Grand Rapids, MI 49506-1678 - Phone
- (616) 913-2011
- Fax
- (616) 913-2005
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 5101007137 | MI | Primary |
| Geriatric Medicine (Family Medicine) Physician | 207QG0300X | 5101006361 | MI |
Addresses
Primary practice location
1471 Grace St SE
Grand Rapids, MI 49506-1678
Mailing address
5900 Byron Center Ave SW
Medical Administration
Grand Rapids, MI 49519-9606
Phone (616) 252-3243
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487618666 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5101007137 | MI | MD | Family Medicine Physician |
| 5101006361 | MI | MD | Geriatric Medicine (Family Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Hospital | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Metro Health Hospital
- General Acute Care Hospital
- Wyoming, MI
- NPI 1619923919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1512432000000",
"number": "1487618666",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5900 BYRON CENTER AVE SW",
"address_2": "MEDICAL ADMINISTRATION",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495199606",
"telephone_number": "616-252-3243",
"fax_number": "616-252-0260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1471 GRACE ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495061678",
"telephone_number": "616-913-2011",
"fax_number": "616-913-2005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARSIGLIA",
"first_name": "GARY",
"middle_name": "L",
"credential": "D.O.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2017-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MI",
"license": "5101007137",
"primary": true
},
{
"code": "207QG0300X",
"taxonomy_group": "",
"desc": "Family Medicine, Geriatric Medicine",
"state": "MI",
"license": "5101006361",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1487618666",
"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 Dec 5, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.