Individual provider Active NPI

Ian Walton Gilbert, DO, MS

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1790570604
Registry record updated Jun 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
5151017452 Issued in MI
Practice address
275 Michigan St NE FL 8
Grand Rapids, MI 49503-2531
Phone
(616) 391-8810
Fax
(616) 391-8897
NPI assigned
Apr 11, 2025
Last updated
Jun 23, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 5151017452 MI Primary

Addresses

Primary practice location

275 Michigan St NE FL 8
Grand Rapids, MI 49503-2531

Mailing address

275 Michigan St NE, Grand Rapids, Mi 49503
8TH Floor
Grand Rapids, MI 49503-2531
Phone (616) 391-8810

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250625000686 MI Order and Referring Only - Pediatric MedicinePractitioner - Pediatric Medicine 6709398746

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy, Master of Science

NPI Registry JSON

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

{
    "created_epoch": "1744329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782172800000",
    "number": "1790570604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 MICHIGAN ST NE, GRAND RAPIDS, MI 49503",
            "address_2": "8TH FLOOR",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032531",
            "telephone_number": "616-391-8810",
            "fax_number": "616-391-8897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 MICHIGAN ST NE FL 8",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032531",
            "telephone_number": "616-391-8810",
            "fax_number": "616-391-8897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILBERT",
        "first_name": "IAN",
        "middle_name": "WALTON",
        "credential": "DO, MS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-04-11",
        "last_updated": "2026-06-23",
        "certification_date": "2026-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "5151017452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.