Individual provider Active NPI

Jamie Leigh Wieber, PH.D., LLP

  • Psychologist
  • Grandville, MI
National Provider Identifier
1184632846
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
6301012428 Issued in MI
Practice address
4211 Parkway Place
Grandville, MI 49418
Phone
(616) 222-3700
NPI assigned
Aug 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 6301012428 MI Primary

Addresses

Primary practice location

4211 Parkway Place
Grandville, MI 49418

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 455-5000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091119000300 MI Practitioner - Clinical Psychologist 1254479827 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pine Rest Christian Mental Health ServicesGroup PAC ID 4981506508, 354 clinicians

Practice addresses (Care Compare)

4211 Pkwy Place SW
Pne Rest Southwest Clinic
Grandville, MI 49418-2385
Phone (616) 222-3700

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
6301012428MIMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Pine Rest Christian Mental Health Services Psychologist CurrentSince Sep 14, 2015 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Sep 14, 2015 Accepting new patients

Locations

4211 Parkway Place Dr SW
Grandville, MI 49418
Phone (616) 222-3700

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

4211 Parkway Place Dr SW
Ste 100
Wyoming, MI 49418
Phone (616) 222-3700

Organizations & group practices 2

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": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184632846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-455-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4211 PARKWAY PLACE",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "49418",
            "telephone_number": "616-222-3700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIEBER",
        "first_name": "JAMIE",
        "middle_name": "LEIGH",
        "credential": "PH.D., LLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301012428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandville, MI

Sources for this page

Verify at the official NPI Registry.