Jordan Profitt, MA, ATC/L

Primary specialty

SpecialistTaxonomy code 174400000X

License

A160577346 Issued in WA

Practice address

607 Dewey Ave NW Ste 300
Grand Rapids, MI 49504-7335

Phone

(253) 332-3398

NPI assigned

Jul 1, 2015

Last updated

Jul 1, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435708800000",
    "number": "1568845139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17927 26TH STREET CT E",
            "city": "LAKE TAPPS",
            "state": "WA",
            "postal_code": "983919408",
            "telephone_number": "253-332-3398"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 DEWEY AVE NW STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495047335",
            "telephone_number": "253-332-3398"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFITT",
        "first_name": "JORDAN",
        "credential": "MA, ATC/L",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WA",
            "license": "A160577346",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.