Individual provider Active NPI

Hussam Shaker

  • Neurology Physician
  • Grand Rapids, MI
National Provider Identifier
1861807315
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
4301105241 Issued in MI
Practice address
245 Cherry St SE Ste 104
Grand Rapids, MI 49503-4607
Phone
(616) 685-5050
Fax
(616) 685-8962
NPI assigned
Jun 24, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 4301105241 MI Primary

Addresses

Primary practice location

245 Cherry St SE Ste 104
Grand Rapids, MI 49503-4607

Mailing address

245 Cherry St SE Ste 104
Grand Rapids, MI 49503-4607
Phone (616) 685-5050

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
I20200708001160 MI Practitioner - Neurology 2860618626 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mercy Health Partners - Physician SpecialistGroup PAC ID 2163572991, 66 clinicians
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Practice addresses (Care Compare)

1675 Leahy St
Suite 401a
Muskegon, MI 49442-5547
Phone (231) 672-4243

220 Cherry St SE
Grand Rapids, MI 49503-4608
Phone (616) 685-5050

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059
  • Trinity Health Muskegon Hospital Hospital, Muskegon, MI, CCN 230066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 1, 2020 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Mercy Health Partners - Physician Specialist CurrentSince Apr 20, 2021 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 1, 2020 Accepting new patients
Advantage Health Physicians PC Past Accepting new patients
Saint Mary'S Health Services Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 Cherry St SE
Ste 104
Grand Rapids, MI 49503
Phone (616) 774-6337

220 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 685-5576

1675 Leahy St
Ste 401A
Muskegon, MI 49442
Phone (231) 672-4243

1500 E Sherman Blvd
Muskegon, MI 49444
Phone (231) 672-3027

Interoperability endpoints

  • Direct secure messaging: hshaker698615@direct.trinity-health.org

Organizations & group practices 6

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.

Hospital & facility affiliations 2

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": "1403568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610668800000",
    "number": "1861807315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 CHERRY ST SE STE 104",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-685-5050",
            "fax_number": "616-685-8962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 CHERRY ST SE STE 104",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034607",
            "telephone_number": "616-685-5050",
            "fax_number": "616-685-8962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAKER",
        "first_name": "HUSSAM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-24",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "MI",
            "license": "4301105241",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.