Active NPI
Keith T Hustak, PA-C
- Physician Assistant
- Grand Rapids, MI
National Provider Identifier
1720149164
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 5601004306
- Practice address
- 100 Michigan St NE
MC-039
Grand Rapids, MI 49503-2560 - Phone
- (616) 486-2196
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5601004306 | MI | Primary |
Addresses
Primary practice location
100 Michigan St NE
MC-039
Grand Rapids, MI 49503-2560
Mailing address
100 Michigan St NE
MC-039
Grand Rapids, MI 49503-2560
Phone (616) 486-2196
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Charles P Catron PSC | Physician Assistant | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448841600000",
"number": "1720149164",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"address_2": "MC-039",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560",
"telephone_number": "616-486-2196"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 MICHIGAN ST NE",
"address_2": "MC-039",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495032560",
"telephone_number": "616-486-2196"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HUSTAK",
"first_name": "KEITH",
"middle_name": "T",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2015-11-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MI",
"license": "5601004306",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.