Jacob Vaughn White, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

6301018202 Issued in MI

Practice address

3537 W. Front Street
Suite F
Traverse City, MI 49684

Phone

(231) 935-8900

NPI assigned

Oct 11, 2018

Last updated

Nov 5, 2019By the provider in NPPES

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

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mary Free Bed Rehabilitation HospitalGroup PAC ID 4587576541, 135 clinicians

Jacob White PH.D., PLLCGroup PAC ID 4385076553, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jacob White PH.D., PLLC

  • Clinical Psychologist
  • Traverse City, MI
  • NPI 1881178325
  Medicare reassignment Care Compare group NPD Authorized official
• Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
  • NPI 1730133463
  Medicare reassignment Care Compare group NPD
• Mary Free Bed Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Rapids, MI
  • NPI 1053550590
  NPD
• Mary Free Bed Rehabilitation Hospital

  dba Mary Free Bed Medical Group

  • Physical Medicine & Rehabilitation Physician
  • Grand Rapids, MI
  • NPI 1053641589
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1539216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572912000000",
    "number": "1548735079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 W. FRONT STREET",
            "address_2": "SUITE F",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-750-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3537 W. FRONT STREET",
            "address_2": "SUITE F",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-935-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHITE",
        "first_name": "JACOB",
        "middle_name": "VAUGHN",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-11",
        "last_updated": "2019-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301018202",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine B Whitaker-Clarke, RN, CDCES
• White Chiropractic Center, PLLC
• Aprille White Truszkowski
• Brandon C. White, D.C.
• Elizabeth Ann White
• Kayleigh White, DO
• Sarah White, NP
• Shelby Lyn White
• Stephen Scott White, D.C.
• Mark Whiting, DMD

• Clinical Psychologist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Clinical Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2019; 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.
• 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.