NPIMap

Individual provider Active NPI

Cyprian A Gardine III, MD

  • Endocrinology, Diabetes & Metabolism Physician
  • Grand Rapids, MI
National Provider Identifier
1659583888
Registry record updated Dec 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
License
4301106353 Issued in MI
Practice address
300 Lafayette Ave SE
Ste 2045
Grand Rapids, MI 49503-4692
Phone
(616) 685-3098
Fax
(616) 685-3095
NPI assigned
May 3, 2007
Last updated
Dec 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Endocrinology, Diabetes & Metabolism Physician 207RE0101X 4301106353 MI Primary

Addresses

Primary practice location

300 Lafayette Ave SE
Ste 2045
Grand Rapids, MI 49503-4692

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008

Other identifiers 1

IdentifierTypeStateIssuer
200861900MedicaidIN

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address cgardine25225@direct.trinity-health.org Direct
Direct Messaging Address cgardine25225@direct.trinity-health.org Direct

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
I20140922000342 MI Practitioner - EndocrinologyPractitioner - Internal Medicine 3971602327 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
EndocrinologyAlso: Internal Medicine
Education
University of Chicago, Pritzker School of Medicine, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Partners - Physician SpecialistGroup PAC ID 2163572991, 66 clinicians

Practice addresses (Care Compare)

1500 E Sherman Blvd
Muskegon, MI 49444-1849
Phone (231) 672-3027

1675 Leahy St
Muskegon, MI 49442-5500

300 Lafayette Ave SE
Suite 2045
Grand Rapids, MI 49503-4692
Phone (616) 685-3098

Hospital & facility affiliations

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 Aug 1, 2014 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
Mercy Health Partners - Physician Specialist CurrentSince Oct 1, 2019 Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Aug 1, 2014 Accepting new patients

Locations

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

300 Lafayette Ave SE
Ste 2045
Grand Rapids, MI 49503
Phone (616) 685-3098

1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027

1675 Leahy St
Ste 301A
Muskegon, MI 49442
Phone (231) 672-8300

Organizations & group practices 4

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 6

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": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639526400000",
    "number": "1659583888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 LAFAYETTE AVE SE",
            "address_2": "STE 2045",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034692",
            "telephone_number": "616-685-3098",
            "fax_number": "616-685-3095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDINE",
        "first_name": "CYPRIAN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-03",
        "last_updated": "2021-12-15",
        "certification_date": "2021-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "MI",
            "license": "4301106353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200861900",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgardine25225@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Physician Partners Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "300 Lafayette Ave SE",
            "address_2": "Ste 2045",
            "city": "Grand Rapids",
            "state": "MI",
            "country_code": "US",
            "postal_code": "495034692",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cgardine25225@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Physician Partners Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "1675 Leahy St Ste 301A",
            "city": "Muskegon",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494425543",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.