Active NPI
Jacob Scott Spiess
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- Kentwood, MI
National Provider Identifier
1568147239
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Sports Medicine (Physical Medicine & Rehabilitation) Physician
- License
- 2601002901
- Practice address
- 6230 Kalamazoo Ave SE
Kentwood, MI 49508-7022 - Phone
- (616) 698-6700
- NPI assigned
- Jun 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 2601002901 | MI | Primary |
Addresses
Primary practice location
6230 Kalamazoo Ave SE
Kentwood, MI 49508-7022
Mailing address
6314 Berkey Southern Rd
Whitehouse, OH 43571-9742
Phone (419) 508-2357
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2601002901 | MI | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687219200000",
"number": "1568147239",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6314 BERKEY SOUTHERN RD",
"city": "WHITEHOUSE",
"state": "OH",
"postal_code": "435719742",
"telephone_number": "419-508-2357"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6230 KALAMAZOO AVE SE",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495087022",
"telephone_number": "616-698-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SPIESS",
"first_name": "JACOB",
"middle_name": "SCOTT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-20",
"last_updated": "2023-06-20",
"certification_date": "2023-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "MI",
"license": "2601002901",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
- Spectrum Health Primary Care Partner
- Spectrum Health Primary Care Partners
- Spectrum Health Primary Care Partners
- Spectrum Health Primary Care Partners
- Sarah Katherine Spencer
- John Devlin Sprague, D.O.
- Jessica Stafford, PHARMD
- Bambi Stalker, MA
- Shelby Marie Stamann, RBT
- Christine Eg Stancle, CBD, CLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.