Active NPI
Matthew Varnell, MA
- Psychologist
- Grand Rapids, MI
National Provider Identifier
1497138234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 5303
- Practice address
- 300 68TH St SE
Grand Rapids, MI 49548-6927 - Phone
- (616) 455-5000
- NPI assigned
- Jun 29, 2015
- Last updated
- May 17, 2019
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301016282 | MI | |
| Psychologist | 103T00000X | 5303 | NC | Primary |
Addresses
Primary practice location
300 68TH St SE
Grand Rapids, MI 49548-6927
Mailing address
501 Eastowne Dr Ste 220
Chapel Hill, NC 27514-6224
Phone (707) 701-3284
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
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301016282 | MI | MD | Psychologist |
| 5303 | NC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1435536000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1558051200000",
"number": "1497138234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "501 EASTOWNE DR STE 220",
"city": "CHAPEL HILL",
"state": "NC",
"postal_code": "275146224",
"telephone_number": "707-701-3284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "300 68TH ST SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495486927",
"telephone_number": "616-455-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VARNELL",
"first_name": "MATTHEW",
"credential": "MA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-06-29",
"last_updated": "2019-05-17",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MI",
"license": "6301016282",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "NC",
"license": "5303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.