GRAND RIVER SURGERY CENTER, LLC
NPI 1124605910
Clinic/Center - Ambulatory Surgical in East Lansing, MI
NPI Status: Active since March 26, 2021
Contact Information
1090 TROWBRIDGE RD STE A
EAST LANSING, MI
ZIP 48823
Phone: (517) 220-0240
Fax: (517) 200-4455
NPPES record last updated: December 8, 2021. Verified against the NPPES registry weekly; last sync: July 12, 2026.
Record update history: Dec 8, 2021, May 6, 2021, Mar 26, 2021 (3 updates tracked since 2021).
- Organization
- Clinic/Center
- Ambulatory Surgical
- Accepts Insurance
- CLIA Number: 23D2217788
- CLIA Cert. Type: Ambulatory Surgery Center
- CLIA Exp. Date: 03-23-2027
About GRAND RIVER SURGERY CENTER, LLC
This page provides the complete NPI Profile along with additional information for Grand River Surgery Center, Llc, a provider established in East Lansing, Michigan operating as a Clinic/center, focusing in ambulatory surgical . The healthcare provider is registered in the NPI registry with number 1124605910 assigned on March 2021. The practitioner's primary taxonomy code is 261QA1903X. The provider is registered as an organization and their NPI record was last updated 5 years ago. The authorized official of this NPI record is Dr. Douglas Dietzel Do (Ceo)
- NPI
- 1124605910
- Provider Name
- GRAND RIVER SURGERY CENTER, LLC
- Entity Type
- Organization
- Location Address
- 1090 TROWBRIDGE RD STE A EAST LANSING, MI 48823
- Location Phone
- (517) 220-0240
- Location Fax
- (517) 200-4455
- Mailing Address
- 1090 TROWBRIDGE RD STE A EAST LANSING, MI 48823
- Mailing Phone
- (517) 282-0851
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-26-2021
- Last Update Date
- 12-08-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Clinic/Center Ambulatory Surgical
- Taxonomy Code
- 261QA1903X
- Type
- Ambulatory Health Care Facilities
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Choice Bronze HSA - HMO
- Choice Bronze HSA + Vision + Adult Dental - HMO
- Clear Gold - HMO
- Clear Gold + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Complete Silver - HMO
- Complete Silver + Vision + Adult Dental - HMO
- Everyday Bronze - HMO
- Everyday Bronze + Vision + Adult Dental - HMO
- Clear Silver - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Everyday Gold - HMO
- Everyday Gold + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Complete Gold - HMO
- Complete Gold + Vision + Adult Dental - HMO
- Elite Gold - HMO
- Elite Gold + Vision + Adult Dental - HMO
- Focused Silver - HMO
- Focused Silver + Vision + Adult Dental - HMO
- Standard Gold - HMO
- Standard Gold + Vision + Adult Dental - HMO
- Standard Silver - HMO
- Standard Silver + Vision + Adult Dental - HMO
- Blue Cross� Preferred HMO Bronze Extra - HMO
- Blue Cross� Preferred HMO Bronze Saver HSA - HMO
- Blue Cross� Preferred HMO Bronze Secure - HMO
- Blue Cross� Preferred HMO Gold - HMO
- Blue Cross� Preferred HMO Gold Extra - HMO
- Blue Cross� Preferred HMO Silver - HMO
- Blue Cross� Preferred HMO Silver Extra - HMO
- Blue Cross� Preferred HMO Silver Saver - HMO
- Blue Cross� Preferred HMO Value - HMO
- Blue Cross� Select HMO Bronze Extra - HMO
- Blue Cross� Premier PPO Bronze Extra - PPO
- Blue Cross� Premier PPO Bronze Saver HSA - PPO
- Blue Cross� Premier PPO Bronze Secure - PPO
- Blue Cross� Premier PPO Gold - PPO
- Blue Cross� Premier PPO Gold Extra - PPO
- Blue Cross� Premier PPO Silver - PPO
- Blue Cross� Premier PPO Silver Extra - PPO
- Blue Cross� Premier PPO Silver Saver HSA - PPO
- Blue Cross� Premier PPO Value - PPO
- MHP Bronze - HMO
- MHP Bronze Saver (Expanded) - HMO
- MHP Expanded Bronze Standard - HMO
- MHP Gold - HMO
- MHP Gold Standard - HMO
- MHP Silver Exchange - HMO
- MHP Silver Exchange Rewards - HMO
- MHP Silver Standard - HMO
- MHP Young Adult/Catastrophic - HMO
- MyPriority Balanced Silver - HMO
- MyPriority Balanced Silver Southeast Michigan Network - HMO
- MyPriority Balanced Silver Trinity Health East Network - HMO
- MyPriority Enhanced Gold Southeast Michigan Network - HMO
- MyPriority Enhanced Gold Trinity Health East Network - HMO
- MyPriority Premier Silver - HMO
- MyPriority Premier Silver Trinity Health East Network - HMO
- MyPriority Standard Bronze - HMO
- MyPriority Standard Bronze - Southeast Michigan Network - HMO
- MyPriority Standard Bronze - Travel - HMO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Areas of Expertise
The following services and procedures, recently provided to Medicare patients, illustrate the range of care this provider offers. This list reflects the variety of services available to all patients visiting the practice and is based on 2022 Medicare dataset. In general, the more frequently a provider treats specific conditions or performs particular procedures, the more experienced they become in addressing similar patient needs. The provider has delivered many of the services listed below to Medicare patients. Please note that this list does not include services provided to patients who are not covered by Medicare.
Full thickness skin graft to nose, ears, eyelids, or lips, 20.0 sq cm or less
Incision of tendon covering of finger
Injection, bupivacaine liposome, 1 mg
Preparation of skin graft site of face, scalp, eyelids, mouth, neck, ears, around eyes, genitals, hands, feet, fingers, or toes, 100.0 sq cm or 1% body area for infants and children, or less
Release and/or relocation of hand nerve
Repair of wound of eyelids, nose, ears, or lips by transferring skin, 10.0 sq cm or less
A full thickness skin graft is a procedure where a layer of skin is taken from one area of the body and transplanted to another. If it's done on the nose, ears, eyelids, or lips, it helps restore these areas when damaged. The size of the graft is 20.0 sq cm or less.
This service was performed 19 times for 19 patientsThis procedure involves making a small cut into the protective sheath around a finger tendon. It's typically done to relieve pressure or inflammation, improve finger movement, or treat conditions like trigger finger. It's a safe, often outpatient procedure.
This service was performed 19 times for 15 patientsBupivacaine liposome is a local anesthetic used to numb a specific area of the body and reduce pain or discomfort associated with surgical procedures. The 1 mg dosage is injected by a healthcare professional at the required site.
This service was performed 4,921 times for 23 patientsThis procedure involves preparing a specific area of your body, such as the face, scalp, neck, or extremities, for a skin graft. A skin graft is a surgical procedure where healthy skin is transferred to an area of the body that has lost skin. This preparation ensures the graft will take hold effectively.
This service was performed 14 times for 14 patientsThis procedure involves adjusting or moving a nerve in your hand to alleviate discomfort or improve function. The nerve may be compressed, causing pain or numbness. By releasing or relocating the nerve, these symptoms can be reduced, enhancing hand usage.
This service was performed 17 times for 16 patientsThis procedure involves repairing a wound on the eyelids, nose, ears, or lips by moving a small piece of skin (10.0 sq cm or less) from one area to another. The goal is to heal the wound and restore the function and appearance of the affected area.
This service was performed 13 times for 13 patientsCLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 23D2217788
- Facility Type
- Ambulatory Surgery Center
- Certificate Effective Date
- March 24, 2025
- Certificate Expiration Date
- March 23, 2027
- Laboratory Director
- AHMED SUFYAN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Grand River Surgery Center, Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1124605910, we treat the final digit (0) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 50. The final step is to find the difference between that total and the next multiple of ten (50 - 50 = 0).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 50 is 50. The difference is the calculated check digit.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1124605910, enumerated as an "organization" on March 26, 2021.
The provider is located at 1090 TROWBRIDGE RD STE A EAST LANSING, MI 48823 and the phone number is (517) 220-0240.
Clinic/Center with taxonomy code 261QA1903X and a focus in Ambulatory Surgical.
The provider might be accepting Accepts: Ambetter from Buckeye Health Plan, Ambetter from. Please consult your insurance carrier or call the provider to verify.
