Derek I Grossman, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5101011248 Issued in MI

Practice address

5365 Hidden Glen Dr
Traverse City, MI 49684-7042

Phone

(989) 621-5014

NPI assigned

Jul 3, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

Practice roles

Locations

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.

• Great Lakes Bay Health Centers

  • Obstetrics & Gynecology Physician
  • Saginaw, MI
  • NPI 1871684761
  Medicare reassignment NPD
• Hospitalist Medicine Physicians of Michigan, PLLC

  • Internal Medicine Physician
  • Adrian, MI
  • NPI 1013180181
  Medicare reassignment NPD
• Sound Inpatient Physicians-Michigan, PLLC

  • Internal Medicine Physician
  • Kalamazoo, MI
  • NPI 1093967861
  Medicare reassignment NPD
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Midland, MI
  • NPI 1609609536
  NPD
• Hospitalist Medicine Physicians of Michigan PLLC

  • Internal Medicine Physician
  • Adrian, MI
  • NPI 1033370283
  NPD
• Sound Inpatient Physicians - Michigan, PLLC

  • Hospitalist Physician
  • Escanaba, MI
  • NPI 1366768178

  Internal Medicine

  NPD
• Kalamazoo Emergency Associates, PLC

  • Emergency Medicine Physician
  • Kalamazoo, MI
  • NPI 1942251244
  NPD (past)
• Mercy Hospital Grayling

  • Hematology & Oncology Physician
  • Grayling, MI
  • NPI 1427489509
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1770512410",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 107",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496850107",
            "telephone_number": "231-922-9270",
            "fax_number": "231-922-9271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5365 HIDDEN GLEN DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847042",
            "telephone_number": "989-621-5014"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842349",
            "country_code": "US",
            "telephone_number": "231-922-9270",
            "fax_number": "231-922-9271",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3023 Davenport Ave",
            "address_purpose": "LOCATION",
            "city": "Saginaw",
            "state": "MI",
            "postal_code": "486023652",
            "country_code": "US",
            "telephone_number": "989-907-2761",
            "fax_number": "989-907-2762",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GROSSMAN",
        "first_name": "DEREK",
        "middle_name": "I",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2021-04-12",
        "certification_date": "2021-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101011248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4892891",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "derek.grossman@direct.medfusion.com",
            "affiliation": "N",
            "address_1": "3023 Davenport Ave",
            "city": "Saginaw",
            "state": "MI",
            "country_code": "US",
            "postal_code": "486023652",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Margaret M Grivas, LMSW-CLINICAL
• Michele G Gronberg
• Bailey S Groseclose II, M.D.
• Carol Elaine Grosmark, LMSW, CAAC
• Amanda Lynn Gross, MSBS, PA-C
• Pamela Grzech, LMSW
• GTC Opco, LLC
• GTP Institutional Phcy
• Guiding Lantern Counseling LLC
• Rosemary Irene Guimond, CHW

• Internal Medicine Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.