Individual provider Active NPI

Jason Tyler Wiersema, D.P.T.

  • Physical Therapist
  • Kalamazoo, MI
National Provider Identifier
1225347321
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501015381 Issued in MI
Practice address
1707 S Park St Ste 100
Kalamazoo, MI 49001-2725
Phone
(269) 234-2942
Fax
(866) 521-5945
NPI assigned
Oct 7, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501015381 MI Primary

Addresses

Primary practice location

1707 S Park St Ste 100
Kalamazoo, MI 49001-2725

Mailing address

5500 Armstrong Rd
Battle Creek, MI 49037-7314
Phone (269) 966-5600

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250206001960 MI Practitioner - Physical Therapist in Private Practice 1759811714 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alliance Physical Therapy Group LLCGroup PAC ID 8921065707, 35 clinicians

Practice addresses (Care Compare)

1707 S Park St
Suite 100
Kalamazoo, MI 49001-2725
Phone (269) 234-2942

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Physical Therapy Group LLC Physical Therapist CurrentSince Jan 31, 2025 Accepting new patients

Locations

601 Michigan Ave
Ste 220
Holland, MI 49423
Phone (616) 355-4284

5886 Venture Park Dr
Kalamazoo, MI 49009
Phone (269) 375-4737

1707 S Park St
Ste 100
Kalamazoo, MI 49001
Phone (269) 234-2942

Organizations & group practices 1

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": "1286409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1225347321",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5500 ARMSTRONG RD",
            "city": "BATTLE CREEK",
            "state": "MI",
            "postal_code": "490377314",
            "telephone_number": "269-966-5600",
            "fax_number": "269-223-5166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1707 S PARK ST STE 100",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490012725",
            "telephone_number": "269-234-2942",
            "fax_number": "866-521-5945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIERSEMA",
        "first_name": "JASON",
        "middle_name": "TYLER",
        "credential": "D.P.T.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-10-07",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501015381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2025; 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.