Individual provider Active NPI

Gary Thomas Sniffen, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1780293993
Registry record updated Aug 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601011057 Issued in MI
Practice address
2902 Bradford St NE
Grand Rapids, MI 49525-6427
Phone
(616) 885-5200
NPI assigned
Jul 24, 2020
Last updated
Aug 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601011057 MI Primary

Addresses

Primary practice location

2902 Bradford St NE
Grand Rapids, MI 49525-6427

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
I20220624000539 MI Practitioner - Physician Assistant 1658791231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

2900 Bradford St NE
Corewell Health Medical Group West
Grand Rapids, MI 49525-6427
Phone (616) 885-5000

2902 Bradford St NE
Corewell Health Medical Group West
Grand Rapids, MI 49525-6427
Phone (616) 486-6577

330 Barclay Ave NE
200 Corewell Health Medical Group West
Grand Rapids, MI 49503-2525
Phone (616) 391-2802

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

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601011057MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Aug 15, 2022 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Aug 15, 2022 Accepting new patients

Locations

705 Oak St
Big Rapids, MI 49307
Phone (231) 592-4356

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

2902 Bradford St NE
Grand Rapids, MI 49525
Phone (616) 486-6577

615 S Bower St
Greenville, MI 48838
Phone (616) 754-4341

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

225 N State St
Reed City, MI 49677
Phone (231) 832-7108

Interoperability endpoints

  • Direct secure messaging: gsniffen480667@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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1595548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1780293993",
    "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": "2902 BRADFORD ST NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495256427",
            "telephone_number": "616-885-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SNIFFEN",
        "first_name": "GARY",
        "middle_name": "THOMAS",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-24",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011057",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.