Individual provider Active NPI

Carrie Lynn Kraker, P.T.

  • Physical Therapist
  • Grandville, MI
National Provider Identifier
1417144940
Registry record updated Aug 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501013494 Issued in MI
Practice address
3380 44TH St SW
Grandville, MI 49418-2461
Phone
(616) 233-3591
NPI assigned
Sep 28, 2007
Last updated
Aug 25, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 5501013494 MI Primary

Addresses

Primary practice location

3380 44TH St SW
Grandville, MI 49418-2461

Mailing address

607 Dewey Ave NW Ste 300
Grand Rapids, MI 49504-7335

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200307000120 MI Practitioner - Physical Therapist in Private Practice 0547698482 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advent Rehabilitation, LLCGroup PAC ID 9537070545, 57 clinicians

Practice addresses (Care Compare)

1471 E Beltline Ave NE
Suite 104
Grand Rapids, MI 49525-4548
Phone (616) 233-3596

1915 Georgetown Ctr Dr
Suite 102
Jenison, MI 49428-7121
Phone (616) 233-5483

3380 44TH St SW
Grandville, MI 49418-2461
Phone (616) 233-3591

3686 32ND Ave
Suite 400
Hudsonville, MI 49426-8546
Phone (616) 377-1010

4085 Burton St SE
Suite 100
Grand Rapids, MI 49546-2444
Phone (616) 233-3599

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advent Rehabilitation, LLC Physical Therapist CurrentSince Jun 9, 2021 Accepting new patients
Alliance Physical Therapy Group LLC Physical Therapist CurrentSince Mar 1, 2020 Accepting new patients
Advent Rehabilitation, LLC Physical Therapist CurrentSince Jun 9, 2021 Accepting new patients

Locations

6745 Fulton St E
Ste D
Ada, MI 49301
Phone (616) 274-1014

4085 Burton St SE
Ste 100
Grand Rapids, MI 49546
Phone (616) 233-3599

150 Jefferson Ave SE
Ste 100
Grand Rapids, MI 49503
Phone (616) 284-3690

625 Kenmoor Ave SE
Ste 100
Grand Rapids, MI 49546

607 Dewey Ave NW
Ste 300
Grand Rapids, MI 49504
Phone (253) 332-3398

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

601 Michigan Ave
Ste 220
Holland, MI 49423
Phone (616) 355-4284

3686 32nd Ave
Ste 400
Hudsonville, MI 49426
Phone (616) 377-1010

1175 Wilson Ave NW
Walker, MI 49534
Phone (616) 284-3686

Organizations & group practices 3

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": "1190937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1408924800000",
    "number": "1417144940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "607 DEWEY AVE NW STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495047335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3380 44TH ST SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182461",
            "telephone_number": "616-233-3591"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAKER",
        "first_name": "CARRIE",
        "middle_name": "LYNN",
        "credential": "P.T.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-28",
        "last_updated": "2014-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501013494",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grandville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2014; 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.

Verify at the official NPI Registry.