NPIMap

Individual provider Active NPI

Jack Heethouse, D.O.

  • Specialist
  • Muskegon, MI
National Provider Identifier
1679523674
Registry record updated Nov 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
5101012999 Issued in MI
Practice address
1400 Mercy Dr.
Suite 100
Muskegon, MI 49444
Phone
(231) 733-1326
Fax
(231) 733-5212
NPI assigned
May 11, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 13, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 5101012999 MI Primary

Addresses

Primary practice location

1400 Mercy Dr.
Suite 100
Muskegon, MI 49444

Mailing address

1400 Mercy Dr.
Suite 100
Michigan, MI 49444
Phone (231) 733-1326

Other identifiers 1

IdentifierTypeStateIssuer
4308380MedicaidMI

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)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
5101012999MIMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedic Specialists of Muskegon PLC Past Accepting new patients

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": "1147305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352764800000",
    "number": "1679523674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR.",
            "address_2": "SUITE 100",
            "city": "MICHIGAN",
            "state": "MI",
            "postal_code": "49444",
            "telephone_number": "231-733-1326",
            "fax_number": "231-733-5212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MERCY DR.",
            "address_2": "SUITE 100",
            "city": "MUSKEGON",
            "state": "MI",
            "postal_code": "49444",
            "telephone_number": "231-733-1326",
            "fax_number": "231-733-5212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEETHOUSE",
        "first_name": "JACK",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-11",
        "last_updated": "2012-11-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "5101012999",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308380",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Muskegon, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2012; 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.