NPIMap

Organization Active NPI

Audio Vestibular Assessment, Inc

  • Audiologist
  • Grand Rapids, MI
National Provider Identifier
1265769947
Registry record updated Mar 7, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
KJ000001 Issued in MI
Legal business name
AUDIO VESTIBULAR ASSESSMENT, INC
Practice address
5344 Plainfield Ave NE
Suite 4
Grand Rapids, MI 49525-1009
Phone
(616) 365-1979
Fax
(616) 365-1964
NPI assigned
Nov 17, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2012

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

Authorized official

Name
Mrs. Karen Ann Jacobs, AUD
Title
Owner/President
Phone
(616) 365-1979

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
AudiologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 231H00000X KJ000001 MI Primary
Hearing and Speech Clinic/Center 261QH0700X KJ000001 MI

Addresses

Primary practice location

5344 Plainfield Ave NE
Suite 4
Grand Rapids, MI 49525-1009

Mailing address

5344 Plainfield Ave NE
Suite 4
Grand Rapids, MI 49525-1009
Phone (616) 365-1979

Other identifiers 2

IdentifierTypeStateIssuer
804687934MedicaidMI
903499018MedicaidMI

Other names 1

  • AVA Hearing Center Doing business as

National Provider Directory

National Provider Directory

Locations

5344 Plainfield Ave NE
Ste 4
Grand Rapids, MI 49525
Phone (616) 365-1979

5344 Plainfield Ave NE
Grand Rapids, MI 49525
Phone (616) 365-1979

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1258416000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331078400000",
    "number": "1265769947",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5344 PLAINFIELD AVE NE",
            "address_2": "SUITE 4",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251009",
            "telephone_number": "616-365-1979",
            "fax_number": "616-365-1964"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5344 PLAINFIELD AVE NE",
            "address_2": "SUITE 4",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495251009",
            "telephone_number": "616-365-1979",
            "fax_number": "616-365-1964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUDIO VESTIBULAR ASSESSMENT, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-17",
        "last_updated": "2012-03-07",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "KAREN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "616-365-1979",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "AUD"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Audiologist",
            "state": "MI",
            "license": "KJ000001",
            "primary": true
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": "MI",
            "license": "KJ000001",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804687934",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "903499018",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AVA Hearing Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Mar 7, 2012; 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.