Active NPI
Alexis Novak
- Physical Therapist
- Jenison, MI
National Provider Identifier
1124883582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501303245
- Practice address
- 1915 Georgetown Center Dr Ste 102
Jenison, MI 49428-7121 - Phone
- (616) 577-8251
- NPI assigned
- Feb 15, 2024
- 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 | 5501303245 | MI | Primary |
Addresses
Primary practice location
1915 Georgetown Center Dr Ste 102
Jenison, MI 49428-7121
Mailing address
625 Kenmoor Ave SE Ste 100
Grand Rapids, MI 49546-2395
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2023
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
625 Kenmoor Ave SE
Suite 100
Grand Rapids, MI 49546-2395
PO Box
Carol Stream, IL 60197
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5501303245 | MI | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1707955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1707955200000",
"number": "1124883582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "625 KENMOOR AVE SE STE 100",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462395"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1915 GEORGETOWN CENTER DR STE 102",
"city": "JENISON",
"state": "MI",
"postal_code": "494287121",
"telephone_number": "616-577-8251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NOVAK",
"first_name": "ALEXIS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-02-15",
"last_updated": "2024-02-15",
"certification_date": "2024-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501303245",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jenison, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- 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.