Active NPI
Michael James Klobucher, PT, DPT, OCS, CMPT
- Physical Therapist
- Rockford, MI
National Provider Identifier
1396039541
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 5501015559
- Practice address
- 65 S Main St
Suite C
Rockford, MI 49341-1286 - Phone
- (616) 866-8084
- Fax
- (616) 866-8085
- NPI assigned
- Jun 6, 2011
- Last updated
- Jul 1, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 5501015559 | MI | Primary |
Addresses
Primary practice location
65 S Main St
Suite C
Rockford, MI 49341-1286
Mailing address
65 S Main St
Suite C
Rockford, MI 49341-1286
Phone (616) 866-8084
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
65 S Main St
Suite C
Rockford, MI 49341-1287
Phone (616) 866-8084
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Shoreline Sport & Spine PLLC | Physical Therapist | Current | Accepting new patients |
| Shoreline Sport & Spine PLLC | Physical Therapist | Current | Accepting new patients |
Locations
65 S Main St
Ste C
Rockford, MI 49341
Phone (616) 866-8084
18000 Cove St
Ste 202
Spring Lake, MI 49456
Phone (616) 847-1280
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1307318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1625097600000",
"number": "1396039541",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "65 S MAIN ST",
"address_2": "SUITE C",
"city": "ROCKFORD",
"state": "MI",
"postal_code": "493411286",
"telephone_number": "616-866-8084",
"fax_number": "616-866-8085"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "65 S MAIN ST",
"address_2": "SUITE C",
"city": "ROCKFORD",
"state": "MI",
"postal_code": "493411286",
"telephone_number": "616-866-8084",
"fax_number": "616-866-8085"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLOBUCHER",
"first_name": "MICHAEL",
"middle_name": "JAMES",
"credential": "PT, DPT, OCS, CMPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-06",
"last_updated": "2021-07-01",
"certification_date": "2021-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MI",
"license": "5501015559",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rockford, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2021; 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.