Active NPI
Glenn Roger Groustra, MD
- Psychiatry Physician
- Ann Arbor, MI
National Provider Identifier
1972761880
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4301023788
- Practice address
- 555 E William St
Suite 22I
Ann Arbor, MI 48104 - Phone
- (734) 663-5242
- Fax
- (734) 663-5242
- NPI assigned
- May 28, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301023788 | MI | Primary |
Addresses
Primary practice location
555 E William St
Suite 22I
Ann Arbor, MI 48104
Mailing address
555 E William St
Suite 22I
Ann Arbor, MI 48104
Phone (734) 663-5242
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Feb 26, 2015 through Feb 26, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301023788 | MI | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1211932800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211932800000",
"number": "1972761880",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "555 E WILLIAM ST",
"address_2": "SUITE 22I",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48104",
"telephone_number": "734-663-5242",
"fax_number": "734-663-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "555 E WILLIAM ST",
"address_2": "SUITE 22I",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48104",
"telephone_number": "734-663-5242",
"fax_number": "734-663-5242"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GROUSTRA",
"first_name": "GLENN",
"middle_name": "ROGER",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-05-28",
"last_updated": "2008-05-28",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301023788",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.