NPIMap

Individual provider Active NPI

Jerod Robert Gardner, DO

  • Family Medicine Physician
  • Grant, MI
National Provider Identifier
1902465743
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5151013975 Issued in MI
Practice address
230 S Maple St
Grant, MI 49327-9006
Phone
(231) 834-5995
NPI assigned
Jun 6, 2019
Last updated
May 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5151013975 MI Primary

Addresses

Primary practice location

230 S Maple St
Grant, MI 49327-9006

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220623000766 MI Practitioner - Family Practice 0446580765 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pennock HospitalGroup PAC ID 4587551015, shared by 7 NPIs, 79 clinicians
Mecosta County Medical CenterGroup PAC ID 1951215540, shared by 6 NPIs, 53 clinicians

Practice addresses (Care Compare)

1 Atkinson Dr
Ludington, MI 49431-1906
Phone (231) 843-2591

12851 W M 179 Hwy
Corewell Health Pennock Hospital
Wayland, MI 49348-9318
Phone (877) 377-7322

230 S Maple
Family Medicine
Grant, MI 49327-9006
Phone (231) 834-5995

5991 95TH Ave
Evart, MI 49631-9386
Phone (231) 832-8700

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Medical Center of West Michigan Family Medicine CurrentSince Dec 29, 2024 Accepting new patients
Memorial Medical Center of West Michigan CurrentSince Dec 29, 2024 Accepting new patients
Spectrum Health Kelsey Past Accepting new patients

Locations

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

230 S Maple St
Grant, MI 49327
Phone (231) 834-5995

1 Atkinson Dr
Ludington, MI 49431
Phone (231) 843-2591

Interoperability endpoints

  • Direct secure messaging: jgardner480661@epic00.corewelldirect.org

Organizations & group practices 4

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.

Hospital & facility affiliations 6

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": "1559779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1902465743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "230 S MAPLE ST",
            "city": "GRANT",
            "state": "MI",
            "postal_code": "493279006",
            "telephone_number": "231-834-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "JEROD",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-06",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5151013975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grant, MI

Sources for this page

Verify at the official NPI Registry.