NPIMap

Organization Active NPI

Vitality at Home

  • Geriatric Physical Therapist
  • Grand Rapids, MI
National Provider Identifier
1235777442
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Physical TherapistTaxonomy code 2251G0304X
Legal business name
VITALITY AT HOME
Practice address
247 Luce St SW
Grand Rapids, MI 49534-9607
Phone
(612) 839-9040
NPI assigned
Dec 18, 2019
Last updated
Dec 27, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

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

Authorized official

Name
Jennafer Smith, DPT, GCSNPI 1558619445
Title
Physical Therapist
Phone
(612) 839-9040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Physical Therapist 2251G0304X NU Primary

Addresses

Primary practice location

247 Luce St SW
Grand Rapids, MI 49534-9607

Mailing address

247 Luce St SW
Grand Rapids, MI 49534-9607
Phone (612) 839-9040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200419000093 MI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 5395175186 Receives reassigned benefits from 6 practitioners
Practice locations: Grand Rapids, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1576627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577404800000",
    "number": "1235777442",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "247 LUCE ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495349607",
            "telephone_number": "612-839-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "247 LUCE ST SW",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495349607",
            "telephone_number": "612-839-9040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VITALITY AT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-18",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "JENNAFER",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "612-839-9040",
        "authorized_official_credential": "DPT, GCS"
    },
    "taxonomies": [
        {
            "code": "2251G0304X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Geriatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.