Thaddeus P. Srutwa, M.D.

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4301045353 Issued in MI

Practice address

16986 Robbins Rd Ste 180
Grand Haven, MI 49417-2795

Phone

(616) 213-0253

Fax

(616) 296-2423

NPI assigned

Jun 2, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• Balance in Life PLC

  • Neuromusculoskeletal Medicine & OMM Physician
  • Spring Lake, MI
  • NPI 1902923246

  Neuromusculoskeletal Medicine & Omm

  NPD (past) Authorized official
• Emergency Health Partners Grand Haven PLC

  • Emergency Medicine Physician
  • Grand Haven, MI
  • NPI 1700950953
  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628121600000",
    "number": "1366489635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16986 ROBBINS RD STE 180",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172795",
            "telephone_number": "616-229-3295",
            "fax_number": "616-229-3295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16986 ROBBINS RD STE 180",
            "city": "GRAND HAVEN",
            "state": "MI",
            "postal_code": "494172795",
            "telephone_number": "616-213-0253",
            "fax_number": "616-296-2423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SRUTWA",
        "first_name": "THADDEUS",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-02",
        "last_updated": "2021-08-05",
        "certification_date": "2021-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "MI",
            "license": "4301045363",
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MI",
            "license": "4301045353",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301045353",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHEILD",
            "identifier": "0700125",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kurt D. Spieske, D.D.S., M.S.
• Margaret Ruth Spoelman, LPC
• Thomas G Spoelman, R.PH.
• Jillian Spofford
• Peter Arkady Srutwa, LLMSW
• Katharine St. Aubin, LCSW, CADC
• Nicole Stanley
• Start and Associates Psychological Support, LLC
• Toni Sue Start, LP
• Margaret Staskiewicz

• All providers in Grand Haven, MI
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.