NPIMap

Organization Active NPI

Internal Medicine of West Michigan PLLC

  • Internal Medicine Physician
  • Grand Rapids, MI
National Provider Identifier
1619028412
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
INTERNAL MEDICINE OF WEST MICHIGAN PLLC
Practice address
3200 Eagle Park Dr NE
Suite 102
Grand Rapids, MI 49525-7057
Phone
(616) 285-9090
Fax
(616) 285-7947
NPI assigned
Jan 16, 2007
Last updated
Oct 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Authorized official

Name
Elizabeth A Kozak, M.D.NPI 1811076805
Title
Partner
Phone
(616) 285-9090

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MI Primary

Addresses

Primary practice location

3200 Eagle Park Dr NE
Suite 102
Grand Rapids, MI 49525-7057

Mailing address

3200 Eagle Park Dr NE
Suite 102
Grand Rapids, MI 49525-7057
Phone (616) 285-9090

Other identifiers 1

IdentifierTypeStateIssuer
G02811OtherMIBLUE CROSS GROUP NUMBER

Other names 1

  • Dr's Marvin, Gans and Roslaniec Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070329000010 MI Part B Supplier - Clinic/Group Practice 9335243484 Receives reassigned benefits from 8 practitioners
Practice locations: Grand Rapids, MI

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1015125Internal Medicine of West Michigan, PLLC3200 Eagle Park Drive, NE Suite 102, Grand Rapids, MI 49525Certificate of waiverJul 23, 2027

National Provider Directory

National Provider Directory

Locations

3200 Eagle Park Dr NE
Grand Rapids, MI 49525
Phone (616) 956-9400

3200 Eagle Park Dr NE
Ste 102
Grand Rapids, MI 49525
Phone (616) 285-8098

Interoperability endpoints

  • FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.70282

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729814400000",
    "number": "1619028412",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 EAGLE PARK DR NE",
            "address_2": "SUITE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257057",
            "telephone_number": "616-285-9090",
            "fax_number": "616-285-7947"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 EAGLE PARK DR NE",
            "address_2": "SUITE 102",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257057",
            "telephone_number": "616-285-9090",
            "fax_number": "616-285-7947"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNAL MEDICINE OF WEST MICHIGAN PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-25",
        "status": "A",
        "authorized_official_last_name": "KOZAK",
        "authorized_official_first_name": "ELIZABETH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "616-285-9090",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP NUMBER",
            "identifier": "G02811",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Dr's Marvin, Gans and Roslaniec",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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 Oct 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.