Individual provider Active NPI

James Dewitt Ide, D.C.

  • Chiropractor
  • Fenton, MI
National Provider Identifier
1073803656
Registry record updated Jan 4, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
08002572A Issued in IN
Practice address
404 Rounds Dr
Fenton, MI 48430-1724
Phone
(317) 774-2998
Fax
(317) 774-3130
NPI assigned
Apr 15, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 08002572A IN Primary

Addresses

Primary practice location

404 Rounds Dr
Fenton, MI 48430-1724

Mailing address

404 Rounds Dr
Fenton, MI 48430-1724
Phone (810) 618-6380

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120518000592 MI Practitioner - Chiropractic 8820251374 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Painless Chiropractic PLLCGroup PAC ID 7810110160, 2 clinicians

Practice addresses (Care Compare)

404 Rounds Dr
Fenton, MI 48430-1724
Phone (810) 208-0424

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
08002572AINMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Painless Chiropractic, PLLC Chiropractor CurrentSince Apr 1, 2014 Accepting new patients

Locations

2803 W Silver Lake Rd
Fenton, MI 48430
Phone (810) 610-6380

404 Rounds Dr
Fenton, MI 48430
Phone (810) 208-0424

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.

NPI Registry JSON

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

{
    "created_epoch": "1302825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1073803656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "404 ROUNDS DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301724",
            "telephone_number": "810-618-6380"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 ROUNDS DR",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484301724",
            "telephone_number": "317-774-2998",
            "fax_number": "317-774-3130"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IDE",
        "first_name": "JAMES",
        "middle_name": "DEWITT",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-15",
        "last_updated": "2021-01-04",
        "certification_date": "2021-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08002572A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fenton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; 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.