Marylynn Joanna Gaastra, PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

5601006007 Issued in MI

Practice address

4118 Kalamazoo Ave SE
Grand Rapids, MI 49508-3605

Phone

(231) 780-6080

NPI assigned

May 3, 2011

Last updated

Jun 6, 2016By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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.

• Lakeview Health Center PC

  • Internal Medicine Physician
  • Lakeview, MI
  • NPI 1538355144
  Medicare reassignment

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1465171200000",
    "number": "1841582327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2749 COIT AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495053505",
            "telephone_number": "616-745-0956"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4118 KALAMAZOO AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495083605",
            "telephone_number": "231-780-6080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAASTRA",
        "first_name": "MARYLYNN",
        "middle_name": "JOANNA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-05-03",
        "last_updated": "2016-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5601006007",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Fuson, MD
• G & H Enterprises, LLC (Vendors Of Hope)
• G R Therapy Services Inc.
• G. C. Meyer, Inc. (Pediatric Orthotic Specialists)
• Lillian Lou Gaastra, PA-S
• Shelbi Raelynne Gabbard, LMHCA, ATR-P
• Stephanie Gabbard
• Makenna Grace Gable
• Caryn Gabrek, RN
• Amy Gackenheimer, PHARMD

• Internal Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, 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 Jun 6, 2016; 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.