Mercy Specialty Services
Organization Active NPI Internal Medicine Physician · Muskegon, MI
NPI 1629010384 · NPPES record last updated Mar 5, 2026
Key facts
- NPI
- 1629010384
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Internal Medicine Physician 207R00000X
- Legal business name
- MERCY SPECIALTY SERVICES
- Practice address
- 1150 E Sherman Blvd Ste 2400
Muskegon, MI 49444 - Phone
- (231) 672-6336
- Fax
- (231) 672-6335
- NPI assigned
- Jun 10, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MERCY HEALTH PARTNERS
Authorized official
- Name
- Michael Gusho
- Title
- Chief Financial Officer
- Phone
- (734) 398-0642
Member of 1
Practitioners 155
-
Andrea F Barber, DO
-
Monica Anna Bowen, D.O.
-
Mathew J Brakora, MD
-
Hans Christian Bruntmyer, D.O.
-
Andrew Cone, PA-C
-
Jennifer Marie Delongpre, D.O.
-
David R Folkmier, D.O.
-
Mark J Foreman, M.D.
-
Zachary Norman Ginsburg, D.O.
-
Branden M Goller, DO
-
Brian David Gradwohl, PHD
-
Darren Lloyd Grunwaldt, D.O.
-
Yaser Yahia Jbara, M.D.
-
Lana Joubert, D.O.
-
Joshua N Kalb, DO
-
Michael Edward Krohn, D.O.
-
Heather Joy Laclair, D.O.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2163361 | Trinity Health Medical Group - Academic Geriatrics | Certificate of waiver | Mar 12, 2027 |
| 23D2164747 | Trinity Health Medical Group | Certificate of waiver | Apr 11, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040429000064 | MI | Part B Supplier - Clinic/Group Practice | 2365439544 |
Receives reassigned benefits from 96 practitioners Practice locations: Norton Shores, MI; Shelby, MI; Muskegon, MI; Grand Haven, MI |
| O20040804001335 | MI | Part B Supplier - Clinic/Group Practice | 2365439544 |
Receives reassigned benefits from 24 practitioners Practice locations: Norton Shores, MI; Grand Haven, MI; Muskegon, MI |
National Provider Directory
- Part of
- Mercy Hospital Ctr Forc
Locations
300 Lafayette Ave SE
Ste 4000
Grand Rapids, MI 49503
Phone (616) 685-6741
125 E Southern Ave
#120
Muskegon, MI 49442
Phone (231) 672-4950
1500 E Sherman Blvd
Ste 240
Muskegon, MI 49444
1675 Leahy St
Ste 304B
Muskegon, MI 49442
Phone (231) 728-1695
1675 Leahy St
Ste 311A
Muskegon, MI 49442
Phone (231) 728-5600
1675 Leahy St
Ste 404B
Muskegon, MI 49442
Phone (231) 728-1695
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neuromusculoskeletal Medicine & OMM Physician |
204D00000X | MI | ||
| Internal Medicine Physician |
207R00000X | MI | Yes | |
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | MI | ||
| Pediatrics Physician |
208000000X | MI | ||
| Physician Assistant |
363A00000X | MI | ||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
1150 E Sherman Blvd Ste 2400
Muskegon, MI 49444
Mailing address
PO Box 776982
Chicago, IL 60677-6982
Phone (800) 494-5797
Other practice location 1
6401 Prairie St Ste 2300
Norton Shores, MI 49444-7842
Phone (231) 727-7928
Other practice location 2
1310 Wisconsin St Ste 200
Grand Haven, MI 49417-2472
Phone (616) 844-4790
Other practice location 3
1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone (231) 672-3883
Other names
- Trinity Health Medical Group
- Mercy General Specialty Services
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service | Other | Cobius Healthcare Solutions |
Other providers in Muskegon, MI
- Mercy Health Partners Sub-Specialty Services
- Mercy Health Partners-Obstetrics and Gynecology Specialist
- Mercy Health Westshore Cardiology Services
- Mercy Hospital - Muskegon SMHC
- Mercy Physician Network
- Mercy Urgent Care
- Mercy Urgent Care
- Mercy Women'S Health Services
- Mary E Meredith
- Glenn E Merz
All providers in Muskegon, MI · Internal Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.