Kyle Niswonger

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

141 E 12TH St
Holland, MI 49423-3607

Phone

(248) 804-7447

NPI assigned

Feb 19, 2015

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ivyrehab Michigan LLCGroup PAC ID 6901165893, 156 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Ivyrehab Michigan, LLC

  • Sports Medicine (Physical Medicine & Rehabilitation) Physician
  • Fenton, MI
  • NPI 1104337120
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1424304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1495670400000",
    "number": "1215329826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2385 MILLBROOK CT",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483063144",
            "telephone_number": "248-804-7447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "141 E 12TH ST",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494233607",
            "telephone_number": "248-804-7447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NISWONGER",
        "first_name": "KYLE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-02-19",
        "last_updated": "2017-05-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ria Anastasia Nieboer, LMSW, CAADC, ADS
• Heidi Nienhuis
• Amanda Nies, D.O.
• Ashley Nicole Nieuwsma, RN
• Maria Guadalupe Nino, CERTIFIED DOULA
• No One Lives Alone
• Olivia Jean Noack, LMSW, ACSW
• Alyssa Noe, LMSW
• Clint Jason Noiseau, DC
• Tim Nolan

• Athletic Trainer in Holland, MI
• Providers in Holland, MI by specialty
• Athletic Trainer in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2017; 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.