NPIMap

Organization Active NPI

Gastroenterology Institute of West Michigan PC

  • Gastroenterology Physician
  • Grand Rapids, MI
National Provider Identifier
1992801138
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
GASTROENTEROLOGY INSTITUTE OF WEST MICHIGAN PC
Practice address
1430 Michigan St NE
Suite a
Grand Rapids, MI 49503-2006
Phone
(616) 459-6146
Fax
(616) 459-9277
NPI assigned
Sep 15, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Shaukat Ali Khan, MD
Title
Doctor
Phone
(616) 459-6146

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X MI Primary

Addresses

Primary practice location

1430 Michigan St NE
Suite a
Grand Rapids, MI 49503-2006

Mailing address

4100 Embassy Dr SE
Suite 200
Grand Rapids, MI 49546-2416
Phone (616) 459-6146

Other identifiers 3

IdentifierTypeStateIssuer
CE4135OtherMIRAILROAD MEDICARE
0D11782OtherMIBCBS
1082851MedicaidMI

National Provider Directory

National Provider Directory

Locations

1430 Michigan St NE
Ste A
Grand Rapids, MI 49503
Phone (616) 459-6146

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992801138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 EMBASSY DR SE",
            "address_2": "SUITE 200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462416",
            "telephone_number": "616-459-6146",
            "fax_number": "616-459-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 MICHIGAN ST NE",
            "address_2": "SUITE A",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032006",
            "telephone_number": "616-459-6146",
            "fax_number": "616-459-9277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTROENTEROLOGY INSTITUTE OF WEST MICHIGAN PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KHAN",
        "authorized_official_first_name": "SHAUKAT",
        "authorized_official_middle_name": "ALI",
        "authorized_official_title_or_position": "DOCTOR",
        "authorized_official_telephone_number": "616-459-6146",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CE4135",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0D11782",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1082851",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.