NPIMap

Organization Active NPI

Trinity Health - Michigan

Doing business as Trinity Health Pharmacy - Roosevelt Park

  • Community/Retail Pharmacy
  • Grand Rapids, MI
National Provider Identifier
1871205575
Registry record updated Dec 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
Legal business name
TRINITY HEALTH - MICHIGAN
Doing business as
Trinity Health Pharmacy - Roosevelt Park
Practice address
730 Cesar E Chavez Ave SW Ste 200
Grand Rapids, MI 49503-4920
Phone
(616) 685-7300
Fax
(616) 685-7309
NPI assigned
Dec 14, 2022
Last updated
Dec 14, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
TRINITY HEALTH - MICHIGANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 14, 2022

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

Authorized official

Name
Robert Casalou
Title
President/Ceo
Phone
(734) 712-3792

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X Primary

Addresses

Primary practice location

730 Cesar E Chavez Ave SW Ste 200
Grand Rapids, MI 49503-4920

Mailing address

730 Cesar E Chavez Ave SW Ste 200
Grand Rapids, MI 49503-4920
Phone (616) 685-7300

Other names 1

  • Trinity Health Pharmacy - Roosevelt Park Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200604002163 MI Part B Supplier - Mass Immunization (Roster Biller Only) 7618878943 7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grand Rapids, MI; Howell, MI; Hudsonville, MI; Livonia, MI; Pontiac, MI; Rockford, MI; Ypsilanti, MI

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Mercy Internal Med Asso

Locations

730 Cesar E Chavez Ave SW
#200
Grand Rapids, MI 49503
Phone (616) 685-7300

NPI Registry JSON

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

{
    "created_epoch": "1670976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1871205575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 CESAR E CHAVEZ AVE SW STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034920",
            "telephone_number": "616-685-7300",
            "fax_number": "616-685-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "730 CESAR E CHAVEZ AVE SW STE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034920",
            "telephone_number": "616-685-7300",
            "fax_number": "616-685-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRINITY HEALTH - MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TRINITY HEALTH - MICHIGAN",
        "enumeration_date": "2022-12-14",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "CASALOU",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "734-712-3792"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Trinity Health Pharmacy - Roosevelt Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.