Individual provider Active NPI

Sally Nur Massry, DO

  • Psychiatry Physician
  • Grand Rapids, MI
National Provider Identifier
1891488813
Registry record updated May 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
5151016400 Issued in MI
Practice address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone
(616) 456-0857
NPI assigned
May 26, 2023
Last updated
May 26, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 26, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 5315242077 MI
Psychiatry Physician 2084P0800X 5151016400 MI Primary

Addresses

Primary practice location

300 68TH St SE
Grand Rapids, MI 49548-6927

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 456-0857

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
I20230727003015 MI Order and Referring Only - PsychiatryPractitioner - Psychiatry 7214398924

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5151016400MIMDPsychiatry Physician
5315242077MIMDPsychiatry Physician

Interoperability endpoints

  • Direct secure messaging: smassry3491342@direct.trinity-health.org

NPI Registry JSON

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

{
    "created_epoch": "1685059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685059200000",
    "number": "1891488813",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-456-0857"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-456-0857"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MASSRY",
        "first_name": "SALLY",
        "middle_name": "NUR",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-26",
        "last_updated": "2023-05-26",
        "certification_date": "2023-05-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5315242077",
            "primary": false
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "5151016400",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.