Individual provider Active NPI

Amanda Schupbach, LAC., DIPL. AC.

  • Acupuncturist
  • Portage, MI
National Provider Identifier
1417792979
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
AcupuncturistTaxonomy code 171100000X
License
5402000297 Issued in MI
Practice address
576 Romence Rd Ste 124
Portage, MI 49024-3436
Phone
(269) 315-5193
NPI assigned
Jun 26, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Acupuncturist 171100000X 5402000297 MI Primary

Addresses

Primary practice location

576 Romence Rd Ste 124
Portage, MI 49024-3436

Mailing address

576 Romence Rd Ste 124
Portage, MI 49024-3436
Phone (269) 315-5193

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
5402000297MIMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Wellspring Acupuncture PLLC Acupuncturist CurrentSince Sep 15, 2024 Accepting new patients

Locations

576 Romence Rd
Ste 124
Portage, MI 49024
Phone (269) 329-7575

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1719360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1417792979",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "576 ROMENCE RD STE 124",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243436",
            "telephone_number": "269-315-5193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "576 ROMENCE RD STE 124",
            "city": "PORTAGE",
            "state": "MI",
            "postal_code": "490243436",
            "telephone_number": "269-315-5193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SCHUPBACH",
        "first_name": "AMANDA",
        "credential": "LAC., DIPL. AC.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-06-26",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171100000X",
            "taxonomy_group": "",
            "desc": "Acupuncturist",
            "state": "MI",
            "license": "5402000297",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portage, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2025; 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.