Individual provider Active NPI

Jacob Kwast, DC

  • Chiropractor
  • Grand Rapids, MI
National Provider Identifier
1528879889
Registry record updated Jan 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301401597 Issued in MI
Practice address
4150 E Beltline Ave NE Ste 3
Grand Rapids, MI 49525-9316
Phone
(616) 447-9888
Fax
(616) 447-9886
NPI assigned
Jan 16, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301401597 MI Primary

Addresses

Primary practice location

4150 E Beltline Ave NE Ste 3
Grand Rapids, MI 49525-9316

Mailing address

4150 E Beltline Ave NE Ste 3
Grand Rapids, MI 49525-9316
Phone (616) 447-9888

Other practice location 1

6690 Crossings Dr SE Ste A
Grand Rapids, MI 49508-7394
Phone (616) 656-1830

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250226000400 MI Practitioner - Chiropractic 9830619485 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Peak Performance Integrated Medicine PLCGroup PAC ID 7012918196, 5 clinicians

Practice addresses (Care Compare)

4150 E Beltline Ave NE
Suite 3
Grand Rapids, MI 49525-9316
Phone (616) 447-9888

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Performance Integrated Medicine, PLC Chiropractor CurrentSince Jan 30, 2025 Accepting new patients

Locations

6690 Crossings Dr SE
Ste A
Grand Rapids, MI 49508
Phone (616) 656-1830

4150 E Beltline Ave NE
Ste 3
Grand Rapids, MI 49525
Phone (616) 447-9888

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": "1736985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1528879889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 E BELTLINE AVE NE STE 3",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259316",
            "telephone_number": "616-447-9888",
            "fax_number": "616-447-9886"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4150 E BELTLINE AVE NE STE 3",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259316",
            "telephone_number": "616-447-9888",
            "fax_number": "616-447-9886"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6690 Crossings Dr SE Ste A",
            "address_purpose": "LOCATION",
            "city": "Grand Rapids",
            "state": "MI",
            "postal_code": "495087394",
            "country_code": "US",
            "telephone_number": "616-656-1830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KWAST",
        "first_name": "JACOB",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-01-16",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301401597",
            "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 Jan 16, 2025; 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.