Mark Louis Gostine, MD

Primary specialty

Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X

License

4301041353 Issued in MI

Practice address

2060 E Paris Ave SE
Suite 200
Grand Rapids, MI 49546-6113

Phone

(616) 285-1377

Fax

(616) 285-1006

NPI assigned

Mar 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• Southern Michigan Pain Consultants PC

  • Interventional Pain Medicine Physician
  • Portage, MI
  • NPI 1538119391
  NPD (past)

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

{
    "created_epoch": "1143676800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620086400000",
    "number": "1619938545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 GLENWOOD HILLS PKWY SE STE 2",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495122091",
            "telephone_number": "616-940-2662",
            "fax_number": "616-940-1965"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2060 E PARIS AVE SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466113",
            "telephone_number": "616-285-1377",
            "fax_number": "616-285-1006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSTINE",
        "first_name": "MARK",
        "middle_name": "LOUIS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-30",
        "last_updated": "2021-05-04",
        "certification_date": "2021-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301041353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "7000027071",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST HEALTH",
            "identifier": "1070467",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "550410415",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1492766",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "40982",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4552951-10",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH MEDICAID",
            "identifier": "7000027071",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4654209-10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leland E Gossett, MD
• Madison Gossett
• Paull Cameron Gossett, MD
• Timothy Duncan Gossett, MD
• Kevin S Gostenik, MD
• Terra Goszulak
• Cornelia F Gotaas
• Erik Gotberg, PHARMD
• Richard F. Gottlieb, M.S.W.
• Lynne M Goudy, PHARMD

• Interventional Pain Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Interventional Pain Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.