Draycen Decator

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

6301017537 Issued in MI

Practice address

3292 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Phone

(616) 365-8920

Fax

(616) 365-8971

NPI assigned

Jul 28, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Behavioral Resources and Institute for Neuropsychological Services

  • Clinical Neuropsychologist
  • Grand Rapids, MI
  • NPI 1023169182
  NPD
• Behavioral Resources and Institute for Neuropsychological Services

  • Physical Therapist
  • Grand Rapids, MI
  • NPI 1467724518
  NPD

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

{
    "created_epoch": "1532736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532736000000",
    "number": "1447738877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3292 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-365-8920",
            "fax_number": "616-365-8971"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3292 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-365-8920",
            "fax_number": "616-365-8971"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECATOR",
        "first_name": "DRAYCEN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-28",
        "last_updated": "2018-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MI",
            "license": "6301017537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Robert Deboer
• Nicholas Deboer, LMSW
• Ronald Debose
• Tyler Debrot
• Krysten Decamp
• Decatur Vein Clinic, Michigan, PC
• Alexander Taylor Decker, LLMSW
• Elaine Joy Decker, M.S., LPC
• Ellen Decker, RN
• Jeffrey Mark Decker, M.D.

• Clinical Neuropsychologist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Clinical Neuropsychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.