NPIMap

Organization Active NPI

Comprehensive Psyiatric Services of Western Mi PC

  • Child & Adolescent Psychiatry Physician
  • Holland, MI
National Provider Identifier
1013095454
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
032227 Issued in MI
Legal business name
COMPREHENSIVE PSYIATRIC SERVICES OF WESTERN MI PC
Practice address
12978 James Street
Ste 10
Holland, MI 49424
Phone
(616) 399-7005
Fax
(616) 399-7150
NPI assigned
Nov 2, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Ronald J Dirkse, MDNPI 1033374368
Title
President Child Psychiatrist
Phone
(616) 399-7005

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2084P0804X 032227 MI Primary

Addresses

Primary practice location

12978 James Street
Ste 10
Holland, MI 49424

Mailing address

12978 James Street
Ste 10
Holland, MI 49424
Phone (616) 399-7005

National Provider Directory

National Provider Directory

Locations

12978 James St
Ste 10
Holland, MI 49424
Phone (616) 394-0112

Practitioners & affiliated clinicians

Practitioners 5

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": "1162425600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1013095454",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12978 JAMES STREET",
            "address_2": "STE 10",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49424",
            "telephone_number": "616-399-7005",
            "fax_number": "616-399-7150"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12978 JAMES STREET",
            "address_2": "STE 10",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "49424",
            "telephone_number": "616-399-7005",
            "fax_number": "616-399-7150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMPREHENSIVE PSYIATRIC SERVICES OF WESTERN MI PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-02",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DIRKSE",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT CHILD PSYCHIATRIST",
        "authorized_official_telephone_number": "616-399-7005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2084P0804X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
            "state": "MI",
            "license": "032227",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.