NPIMap

Organization Active NPI

139 Education, LLC

Doing business as Neurocore

  • Psychologist
  • Grand Rapids, MI
National Provider Identifier
1114290517
Registry record updated Feb 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301009353 Issued in MI
Legal business name
139 EDUCATION, LLC
Doing business as
Neurocore
Practice address
1971 E Beltline Ave NE
Suite 212
Grand Rapids, MI 49525-7045
Phone
(800) 600-4096
NPI assigned
Feb 15, 2012
Last updated
Feb 15, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2012

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

Authorized official

Name
Dr. Timothy RoyerNPI 1326388554
Title
Owner
Phone
(616) 706-5649

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
PsychologistGroup: 193400000X SINGLE SPECIALTY GROUP 103T00000X 6301009353 MI Primary

Addresses

Primary practice location

1971 E Beltline Ave NE
Suite 212
Grand Rapids, MI 49525-7045

Mailing address

3790 30TH St SW
Grandville, MI 49418-1602
Phone (800) 600-4096

Other identifiers 2

IdentifierTypeStateIssuer
1013294628OtherMINPI #
0D14689OtherMIBLUE CROSS BLUE SHIELD OF MICHIGAN

Other names 1

  • Neurocore Doing business as

National Provider Directory

National Provider Directory
Tax ID family
139 Education LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1971 E Beltline Ave NE
Ste 212
Grand Rapids, MI 49525

3790 30th St SW
Grandville, MI 49418

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1329264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329264000000",
    "number": "1114290517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3790 30TH ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494181602",
            "telephone_number": "800-600-4096",
            "fax_number": "800-606-8839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1971 E BELTLINE AVE NE",
            "address_2": "SUITE 212",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495257045",
            "telephone_number": "800-600-4096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "139 EDUCATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-15",
        "last_updated": "2012-02-15",
        "status": "A",
        "authorized_official_last_name": "ROYER",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-706-5649",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301009353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1013294628",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF MICHIGAN",
            "identifier": "0D14689",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Neurocore",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Feb 15, 2012; 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.