Amanda M Converse I, LMT

Primary specialty

Massage TherapistTaxonomy code 225700000X

License

7501002519 Issued in MI

Practice address

525 Elliott Ave
Grand Haven, MI 49417-1038

Phone

(616) 566-1603

NPI assigned

Oct 21, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• I-Revive PLLC

  • Preventive Medicine/Occupational Environmental Medicine Physician
  • Grand Haven, MI
  • NPI 1508473000
  NPD Authorized official

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

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1205435161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 ELLIOTT AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494171038",
            "telephone_number": "616-566-1603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 ELLIOTT AVE",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494171038",
            "telephone_number": "616-566-1603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONVERSE",
        "first_name": "AMANDA",
        "middle_name": "M",
        "name_suffix": "I",
        "credential": "LMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-21",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172M00000X",
            "taxonomy_group": "",
            "desc": "Mechanotherapist",
            "state": null,
            "license": "7501002519",
            "primary": false
        },
        {
            "code": "225700000X",
            "taxonomy_group": "",
            "desc": "Massage Therapist",
            "state": "MI",
            "license": "7501002519",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "7501002519",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "info@converseunited.com",
            "affiliation": "Y",
            "endpointDescription": "secure direct email",
            "affiliationName": "i-Revive pllc",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "secure direct email",
            "address_1": "525 Elliott Ave",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494171038",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "support@i-revive.org",
            "affiliation": "N",
            "endpointDescription": "secured  email",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "525 Elliott Ave",
            "city": "Grand Haven",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494171038",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary L Cole, RD
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• Massage Therapist in Grand Haven, MI
• Providers in Grand Haven, MI by specialty
• Massage Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; 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.