Individual provider Active NPI

Martin J Sytsema, OMPT

  • Physical Therapist
  • Spring Lake, MI
National Provider Identifier
1447289277
Registry record updated Jul 1, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
5501008946 Issued in MI
Practice address
18000 Cove Street
Suite 202
Spring Lake, MI 49456-1383
Phone
(616) 847-1280
Fax
(616) 847-1290
NPI assigned
Jul 2, 2006
Last updated
Jul 1, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 1, 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 5501008946 MI Primary

Addresses

Primary practice location

18000 Cove Street
Suite 202
Spring Lake, MI 49456-1383

Mailing address

18000 Cove Street
Suite 202
Spring Lake, MI 49456-1383
Phone (616) 847-1280

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050705000328 MI Practitioner - Physical Therapist in Private Practice 9638115330 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shoreline Sport and Spine PLLCGroup PAC ID 4284673575, 44 clinicians

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

State licenses

LicenseStateTypeSpecialty
5501008946MIMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Shoreline Sport & Spine PLLC Physical Therapist CurrentSince Jun 6, 2005 Accepting new patients
Shoreline Sport & Spine PLLC Physical Therapist CurrentSince Jun 6, 2005 Accepting new patients

Locations

900 W Western Ave
Ste 202
Muskegon, MI 49441

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 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": "1151798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404172800000",
    "number": "1447289277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18000 COVE STREET",
            "address_2": "SUITE 202",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494561383",
            "telephone_number": "616-847-1280",
            "fax_number": "616-847-1290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18000 COVE STREET",
            "address_2": "SUITE 202",
            "city": "SPRING LAKE",
            "state": "MI",
            "postal_code": "494561383",
            "telephone_number": "616-847-1280",
            "fax_number": "616-847-1290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYTSEMA",
        "first_name": "MARTIN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "OMPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-02",
        "last_updated": "2014-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501008946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spring Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 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.