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ADDRESS HEALTHCARE OF MICHIGAN PLLC
NPI 1043075294
Internal Medicine in Grand Rapids, MI

Active since February 16, 2024
600 MONROE AVENUE NW, STE 104, GRAND RAPIDS, MI 49503(616) 366-4234(855) 548-4481 Get Directions Write a Review

NPPES record last updated: May 5, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Address Healthcare Of Michigan Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ADDRESS HEALTHCARE OF MICHIGAN PLLC (NPI 1043075294), doing business as Address Healthcare, is a healthcare organization registered as an internal medicine in Grand Rapids, Michigan and active in the NPI registry since February 2024. The organization lists Jeffrey L Wacksman, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1043075294
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameADDRESS HEALTHCARE OF MICHIGAN PLLC
Location Address600 MONROE AVENUE NW, STE 104Grand Rapids, MI 49503-1470
Mailing Address3940 Peninsular Drive Se, Ste 230Grand Rapids, MI 49546-2442 · (616) 366-4234 · Fax (855) 548-4481
Phone(616) 366-4234
Fax(855) 548-4481
Organization SubpartNo
Authorized OfficialJeffrey L WacksmanAuthorized Official · (616) 366-4234
Enumeration DateFebruary 16, 2024
Last NPPES UpdateMay 5, 2025
NPPES CertifiedApril 18, 2025
✔ NPI 1043075294 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 6

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedOptometristTaxonomy 152W00000X
Also ListedInternal Medicine · Hospice and Palliative MedicineTaxonomy 207RH0002X
Also ListedPsychiatry & Neurology · Geriatric PsychiatryTaxonomy 2084P0805X
Also ListedPodiatrist · Foot & Ankle SurgeryTaxonomy 213ES0103X
Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X
600 MONROE AVENUE NW, Grand Rapids, MI 49503
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Other Names 2

Doing Business AsAddress Healthcare
Doing Business AsAddress Healthcare Of Michigan

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Address Healthcare Of Michigan Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

2

Medicare enrollment records show 2 clinicians reassign Medicare billing to Address Healthcare Of Michigan PLLC, which bills Medicare for the services they deliver. They are listed nearest first.

Clinicians, nearest first (2)

Christi Gagliano, APRN
Nurse Practitioner
NPI 1205884269
6804 CECELIA DR
New Port Richey, FL 34653
(855) 232-0644
✔ PECOS✔ Accepts Medicare1,030 mi
Peter Radice, M.D.
Hospice/Palliative Care
NPI 1356339170
6804 CECELIA DR
New Port Richey, FL 34653
(855) 232-0644
✔ PECOS✔ Accepts Medicare1,030 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Address Healthcare Of Michigan PLLC's NPI number?

The NPI number for Address Healthcare Of Michigan PLLC is 1043075294. It was assigned to this organization in the NPPES registry on February 16, 2024. The provider is doing business as Address Healthcare and Address Healthcare of Michigan.

Where is Address Healthcare Of Michigan PLLC located?

Address Healthcare Of Michigan PLLC is located at 600 Monroe Avenue NW Ste 104, Grand Rapids, MI 49503. The listed phone number is (616) 366-4234.

What is Address Healthcare Of Michigan PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Address Healthcare Of Michigan PLLC enrolled in Medicare?

Yes. Address Healthcare Of Michigan PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Address Healthcare Of Michigan PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 2 clinicians reassign their Medicare billing to Address Healthcare Of Michigan PLLC, in Hospice/Palliative Care and Nurse Practitioner. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Address Healthcare Of Michigan PLLC accept?

Health plans from Blue Care Network of Michigan list Address Healthcare Of Michigan PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Address Healthcare Of Michigan PLLC was last updated on May 5, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.