Individual provider Active NPI

Sean Anson Medlin, D.C.

  • Chiropractor
  • Grand Rapids, MI
National Provider Identifier
1053605782
Registry record updated May 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301009829 Issued in MI
Practice address
1500 E Beltline Ave SE
145
Grand Rapids, MI 49506-4361
Phone
(703) 606-8287
NPI assigned
May 28, 2011
Last updated
May 28, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301009829 MI Primary

Addresses

Primary practice location

1500 E Beltline Ave SE
145
Grand Rapids, MI 49506-4361

Mailing address

1500 E Beltline Ave SE
145
Grand Rapids, MI 49506-4361
Phone (703) 606-8287

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110818000239 MI Practitioner - Chiropractic 7315116886 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Life Chiropractic College, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1500 E Beltline Ave SE
Suite 145
Grand Rapids, MI 49506-4360
Phone (616) 608-3606

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301009829MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Clear Connections Chiropractic PLLC Chiropractor CurrentSince Jul 12, 2011 Accepting new patients

Locations

1500 E Beltline Ave SE
Ste 145
Grand Rapids, MI 49506
Phone (586) 255-2772

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1306540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1306540800000",
    "number": "1053605782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 E BELTLINE AVE SE",
            "address_2": "145",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064361",
            "telephone_number": "703-606-8287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E BELTLINE AVE SE",
            "address_2": "145",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064361",
            "telephone_number": "703-606-8287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDLIN",
        "first_name": "SEAN",
        "middle_name": "ANSON",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-28",
        "last_updated": "2011-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009829",
            "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 May 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.