NPIMap

Organization Active NPI

West Michigan Surgical Specialists PLC

  • Surgery Physician
  • Wyoming, MI
National Provider Identifier
1679508659
Registry record updated Jan 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
DB041912 Issued in MI
Legal business name
WEST MICHIGAN SURGICAL SPECIALISTS PLC
Practice address
1045 Gezon Pkwy SW
Wyoming, MI 49509-9542
Phone
(616) 456-5311
Fax
(616) 456-7955
NPI assigned
Jul 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2021

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

Authorized official

Name
Daniel K Borreson, M.D.NPI 1245211796
Title
M.D./President
Phone
(616) 456-5311

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
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X DB041912 MI Primary

Addresses

Primary practice location

1045 Gezon Pkwy SW
Wyoming, MI 49509-9542

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
0D16117OtherMIBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040513001072 MI Part B Supplier - Clinic/Group Practice 3870583727 Receives reassigned benefits from 13 practitioners
Practice locations: Wyoming, MI

National Provider Directory

National Provider Directory

Locations

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

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1609804800000",
    "number": "1679508659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1045 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099542",
            "telephone_number": "616-456-5311",
            "fax_number": "616-456-7955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST MICHIGAN SURGICAL SPECIALISTS PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2021-01-05",
        "certification_date": "2021-01-05",
        "status": "A",
        "authorized_official_last_name": "BORRESON",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "M.D./PRESIDENT",
        "authorized_official_telephone_number": "616-456-5311",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "MI",
            "license": "DB041912",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0D16117",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wyoming, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.