GREAT LAKES NEUROSURGICAL ASSOCIATES, PC
NPI 1366590929
Neurological Surgery in Grand Rapids, MI

Active since January 08, 2007
3350 EAGLE PARK DR NE STE 102, GRAND RAPIDS, MI 49525(616) 454-3465 Get Directions Write a Review

NPPES record last updated: October 24, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Great Lakes Neurosurgical Associates, Pc NPPES

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

GREAT LAKES NEUROSURGICAL ASSOCIATES, PC (NPI 1366590929) is a healthcare organization registered as a neurological surgery in Grand Rapids, Michigan and active in the NPI registry since January 2007. The organization lists Lisa Santos, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1366590929
Entity TypeOrganization
Primary Taxonomy207T00000X
Legal Business NameGREAT LAKES NEUROSURGICAL ASSOCIATES, PC
Location Address3350 EAGLE PARK DR NE STE 102Grand Rapids, MI 49525-4570
Mailing Address3350 Eagle Park Dr Ne Ste 102Grand Rapids, MI 49525-4570 · (616) 454-3465
Organization SubpartNo
Authorized OfficialLisa SantosExecutive Director · (616) 242-7042
Enumeration DateJanuary 8, 2007
Last NPPES UpdateOctober 24, 2023
NPPES CertifiedOctober 24, 2023
✔ NPI 1366590929 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNeurological SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code207T00000X
License✔ Licensed in MI · LH029420
Definition
A neurological surgeon provides the operative and non-operative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes which modify function or activity of the nervous system; and the operative and non-operative management of pain. A neurological surgeon treats patients with disorders of the nervous system; disorders of the brain, meninges, skull, and their blood supply, including the extracranial carotid and vertebral arteries; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those which may require treatment by spinal fusion or instrumentation; and disorders of the cranial and spinal nerves throughout their distribution.
3350 EAGLE PARK DR NE STE 102, Grand Rapids, MI 49525

Other Identifiers 6

Other1245311059MI · Npi
Other1326144049MI · Npi
Other1497836282MI · Npi
Other1659452472MI · Npi
Other1225119027MI · Npi
Other1770664583MI · Npi

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Great Lakes Neurosurgical Associates, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Medicare Revalidation Due Date

Revalidation due by October 31, 2026

Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.

StateEnrollment IDDue date
StateMichiganEnrollment IDO20031209000125Non-DME Part B · Clinic/Group PracticeDue dateOctober 31, 2026
Source: CMS Revalidation Due Date List, October 2026 release.

Clinicians Billing Medicare Through This Organization

7

Medicare enrollment records show 7 clinicians reassign Medicare billing to Great Lakes Neurosurgical Associates, PC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 6 within 10 miles. They are listed nearest first.

Clinicians, nearest first (7)

Neurosurgery
NPI 1770664583
3350 EAGLE PARK DR NE STE 102
Grand Rapids, MI 49525
(616) 454-3465
✔ PECOS✔ Accepts MedicareSame address
Neurosurgery
NPI 1578650123
3350 EAGLE PARK DR NE STE 102
Grand Rapids, MI 49525
(616) 454-3465
✔ PECOS✔ Accepts MedicareSame address
Neurosurgery
NPI 1598945644
414 PLYMOUTH NE
Grand Rapids, MI 49505
(616) 454-3465
✔ PECOS✔ Accepts Medicare2.1 mi
Neurosurgery
NPI 1841368685
414 PLYMOUTH AVE NE
Grand Rapids, MI 49505
(616) 242-7057
✔ PECOS✔ Accepts Medicare2.1 mi
Neurosurgery
NPI 1275791774
414 PLYMOUTH AVE NE
Grand Rapids, MI 49505
(616) 454-3465
✔ PECOS✔ Accepts Medicare2.1 mi
Nurse Practitioner
NPI 1104147792
100 MICHIGAN ST NE
Grand Rapids, MI 49503
(616) 391-2932
✔ PECOS✔ Accepts Medicare4.1 mi
Neurosurgery
NPI 1154587426
908 N ELM ST STE 202
Hinsdale, IL 60521
(630) 856-8640
✔ PECOS✔ Accepts Medicare144 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 Great Lakes Neurosurgical Associates, PC's NPI number?

The NPI number for Great Lakes Neurosurgical Associates, PC is 1366590929. It was assigned to this organization in the NPPES registry on January 8, 2007.

Where is Great Lakes Neurosurgical Associates, PC located?

Great Lakes Neurosurgical Associates, PC is located at 3350 Eagle Park Dr NE Ste 102, Grand Rapids, MI 49525. The listed phone number is (616) 454-3465.

What is Great Lakes Neurosurgical Associates, PC's specialty?

The primary specialty registered for this NPI is Neurological Surgery with taxonomy code 207T00000X.

Is Great Lakes Neurosurgical Associates, PC enrolled in Medicare?

Yes. Great Lakes Neurosurgical Associates, PC is registered in the Medicare PECOS enrollment system.

When is Great Lakes Neurosurgical Associates, PC's Medicare revalidation due?

According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Michigan, Clinic/Group Practice) is due for revalidation by October 31, 2026. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.

How many clinicians bill Medicare through Great Lakes Neurosurgical Associates, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 7 clinicians in 2 Medicare specialties reassign their Medicare billing to Great Lakes Neurosurgical Associates, PC. 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. The largest specialties are Neurosurgery (6) and Nurse Practitioner (1). Of these, 2 practice at this address and 6 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Great Lakes Neurosurgical Associates, PC accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Great Lakes Neurosurgical Associates, PC 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 Great Lakes Neurosurgical Associates, PC was last updated on October 24, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years 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.