Active NPI
Linda Marie Rusiecki, DPT
- Physical Therapist
- Grand Rapids, MI
National Provider Identifier
1043458342
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501014127
- Practice address
- 4100 Lake Dr. SE
Ste 305
Grand Rapids, MI 49546 - Phone
- (616) 285-1377
- Fax
- (616) 285-1006
- NPI assigned
- Jan 26, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501014127 | MI | Primary |
Addresses
Primary practice location
4100 Lake Dr. SE
Ste 305
Grand Rapids, MI 49546
Mailing address
61 Commerce Ave SW
Grand Rapids, MI 49503
Phone (616) 940-0660
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501014127 | MI | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Michigan Pain Consultants PC | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/EJDADD
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Pain Medicine (Anesthesiology) Physician
- Grand Rapids, MI
- NPI 1467418574
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1232928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1247788800000",
"number": "1043458342",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "61 COMMERCE AVE SW",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49503",
"telephone_number": "616-940-0660",
"fax_number": "616-940-1965"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 LAKE DR. SE",
"address_2": "STE 305",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "49546",
"telephone_number": "616-285-1377",
"fax_number": "616-285-1006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUSIECKI",
"first_name": "LINDA",
"middle_name": "MARIE",
"name_prefix": "Dr.",
"credential": "DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-01-26",
"last_updated": "2009-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501014127",
"primary": true
}
],
"identifiers": [],
"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 17, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.