NPIMap

Individual provider Active NPI

Roxanne Kyriakakis, MD

  • Surgery Physician
  • Grand Rapids, MI
National Provider Identifier
1598285173
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301112945 Issued in MI
Practice address
221 Michigan St NE Ste 200-a
Grand Rapids, MI 49503-2543
Phone
(616) 391-1405
Fax
(616) 391-8611
NPI assigned
Jun 23, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301112945 MI Primary
Surgery Physician 208600000X 4301506900 MI
Colon & Rectal Surgery Physician 208C00000X 4301506900 MI

Addresses

Primary practice location

221 Michigan St NE Ste 200-a
Grand Rapids, MI 49503-2543

Mailing address

221 Michigan St NE Ste 200-a
Grand Rapids, MI 49503-2543
Phone (616) 391-1405

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
I20231107000406 MI Practitioner - General Surgery 5991077216 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
University of South Carolina School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Surgical Specialists PLCGroup PAC ID 3870583727, 11 clinicians

Practice addresses (Care Compare)

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone (616) 456-5311

250 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5600

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Feb 1, 2024 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
West Michigan Surgical Specialists PLC Surgery CurrentSince Nov 1, 2023 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Feb 1, 2024 Accepting new patients
Saint Mary's Health Services Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

250 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 685-5600

1045 Gezon Pkwy SW
Wyoming, MI 49509
Phone (616) 456-5311

Interoperability endpoints

  • Direct secure messaging: rkyriakakis44670@direct.trinity-health.org

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1498176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1598285173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE STE 200-A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032543",
            "telephone_number": "616-391-1405",
            "fax_number": "616-391-8611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE STE 200-A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032543",
            "telephone_number": "616-391-1405",
            "fax_number": "616-391-8611"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KYRIAKAKIS",
        "first_name": "ROXANNE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-23",
        "last_updated": "2022-07-21",
        "certification_date": "2022-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301112945",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301506900",
            "primary": false
        },
        {
            "code": "208C00000X",
            "taxonomy_group": "",
            "desc": "Colon & Rectal Surgery",
            "state": "MI",
            "license": "4301506900",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.