NPIMap

Organization Active NPI

Michiana Spine, Sports & Occupational Rehab, PC

  • Interventional Pain Medicine Physician
  • Niles, MI
National Provider Identifier
1386902013
Registry record updated Nov 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
License
4301070312 Issued in MI
Legal business name
MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC
Practice address
24 N Saint Joseph Ave Ste B
Niles, MI 49120-2263
Phone
(574) 252-4150
Fax
(574) 252-4159
NPI assigned
May 1, 2012
Last updated
Nov 3, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2022

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

Authorized official

Name
Kevin G Drew, MDNPI 1275538373
Title
Owner
Phone
(574) 252-4150

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
Interventional Pain Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208VP0014X 4301070312 MI Primary

Addresses

Primary practice location

24 N Saint Joseph Ave Ste B
Niles, MI 49120-2263

Mailing address

3740 Edison Lakes Pkwy
Mishawaka, IN 46545-3474
Phone (574) 252-4150

National Provider Directory

National Provider Directory

Locations

2946 Division St
Saint Joseph, MI 49085
Phone (213) 232-5630

1123 W Broadway St
Ste 9
Three Rivers, MI 49093
Phone (888) 734-2246

Practitioners & affiliated clinicians

Practitioners 8

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": "1335830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667433600000",
    "number": "1386902013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 EDISON LAKES PKWY",
            "city": "MISHAWAKA",
            "state": "IN",
            "postal_code": "465453474",
            "telephone_number": "574-252-4150",
            "fax_number": "574-252-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE STE B",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "574-252-4150",
            "fax_number": "574-252-4159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHIANA SPINE, SPORTS & OCCUPATIONAL REHAB, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-01",
        "last_updated": "2022-11-03",
        "certification_date": "2022-11-03",
        "status": "A",
        "authorized_official_last_name": "DREW",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "574-252-4150",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "MI",
            "license": "4301070312",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2022; 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.