NPIMap

Individual provider Active NPI

Marc Oliver Gosselin, DO

  • Cardiovascular Disease Physician
  • Saint Clair Shores, MI
National Provider Identifier
1508814989
Registry record updated Dec 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
5101010983 Issued in MI
Practice address
24211 Little Mack Ave
St Clair Shores, MI 48080-1190
Phone
(586) 498-0440
Fax
(586) 498-0401
NPI assigned
May 5, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 5101010983 MI Primary

Addresses

Primary practice location

24211 Little Mack Ave
St Clair Shores, MI 48080-1190

Mailing address

24211 Little Mack Ave
St Clair Shores, MI 48080-1190
Phone (586) 498-0440

Other identifiers 2

IdentifierTypeStateIssuer
3474289MedicaidMI
11OtherMI11

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mgosselin31440@direct.beaumont.edu

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
I20090205000475 MI Practitioner - Interventional CardiologyPractitioner - Cardiovascular Disease (Cardiology)Practitioner - Internal Medicine 8426112467 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Interventional Cardiology
Education
University of New England, College of Osteo Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastlake Cardiovascular PCGroup PAC ID 4688562176, 22 clinicians

Practice addresses (Care Compare)

2061 W Auburn Rd
Rochester Hills, MI 48309-3631
Phone (586) 498-0440

22101 Moross Rd
Detroit, MI 48236-2148
Phone (586) 753-0011

24211 Little Mack Ave
Saint Clair Shores, MI 48080-1151
Phone (810) 498-0440

43650 Garfield Rd
Suite 100
Clinton Township, MI 48038-7419
Phone (586) 498-0440

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.31 of 100Reported as group
Quality
66.77
Promoting interoperability
100
Improvement activities
40
Cost
76.8

Procedures performed for Medicare patients

ProcedureNumber of procedures
Coronary angioplasty and stenting24
Pacemaker insertion or repair1-10
Varicose vein removal1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101010983MIMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Providence Hospital CurrentSince Jan 14, 2026 Accepting new patients
Henry Ford Health Providence Hospital Cardiovascular Disease CurrentSince Jan 14, 2026 Accepting new patients
Henry Ford Health Providence Hospital Past Accepting new patients

Locations

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

22201 Moross Rd
Grosse Pointe Woods, MI 48236
Phone (313) 343-3481

Interoperability endpoints

  • Direct secure messaging: mgosselin31440@direct.beaumont.edu

Organizations & group practices 6

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 7

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": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606780800000",
    "number": "1508814989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24211 LITTLE MACK AVE",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801190",
            "telephone_number": "586-498-0440",
            "fax_number": "586-498-0401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24211 LITTLE MACK AVE",
            "city": "ST CLAIR SHORES",
            "state": "MI",
            "postal_code": "480801190",
            "telephone_number": "586-498-0440",
            "fax_number": "586-498-0401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSSELIN",
        "first_name": "MARC",
        "middle_name": "OLIVER",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2020-12-01",
        "certification_date": "2020-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": "5101010983",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3474289",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "11",
            "identifier": "11",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mgosselin31440@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "24211 Little Mack Ave",
            "city": "St Clair Shores",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480801190",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Saint Clair Shores, MI

Sources for this page

Verify at the official NPI Registry.