Individual provider Active NPI

Marissa Beth Roslyn-Clark, NP

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1679734941
Registry record updated Apr 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704346505 Issued in MI
Practice address
3800 Lake Michigan Dr NW Ste a
Grand Rapids, MI 49534-4583
Phone
(616) 267-8225
NPI assigned
Jun 19, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704346505 MI Primary

Addresses

Primary practice location

3800 Lake Michigan Dr NW Ste a
Grand Rapids, MI 49534-4583

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230511002199 MI Practitioner - Nurse Practitioner 5092004960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Practice addresses (Care Compare)

2750 E Beltline Ave NE
Corewell Health Medical Group West
Grand Rapids, MI 49525-8614
Phone (616) 267-8950

2750 E Beltline Ave NE FL
Grand Rapids, MI 49525-8614

2770 E Beltline Ave NE
Grand Rapids, MI 49525-8614
Phone (616) 267-8860

3800 Lake Michigan Dr NW a
Corewell Health Medical Group West
Grand Rapids, MI 49534-4583
Phone (616) 453-8225

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Jun 26, 2023 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jun 26, 2023 Accepting new patients

Locations

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

3800 Lake Michigan Dr NW
Ste A
Grand Rapids, MI 49534
Phone (616) 267-8225

4069 Lake Dr SE
Ste 118
Grand Rapids, MI 49546
Phone (616) 267-8520

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

Interoperability endpoints

  • Direct secure messaging: mroslynclark261744@epic00.corewelldirect.org

Organizations & group practices 2

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.

Hospital & facility affiliations 2

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": "1213833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713139200000",
    "number": "1679734941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3800 LAKE MICHIGAN DR NW STE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495344583",
            "telephone_number": "616-267-8225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSLYN-CLARK",
        "first_name": "MARISSA",
        "middle_name": "BETH",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-06-19",
        "last_updated": "2024-04-15",
        "certification_date": "2024-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704346505",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.