John J Iacobucci, M.D.

Primary specialty

Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X

License

4301047493 Issued in MI

Practice address

221 Michigan St NE Ste 300
Grand Rapids, MI 49503-2537

Phone

(616) 391-1909

Fax

(616) 391-8612

NPI assigned

Oct 5, 2006

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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 and National Provider Directory roles.

• Breast Health & Wellness Center PC

  • Surgery Physician
  • Grand Rapids, MI
  • NPI 1710378989
  NPD
• Michigan Medical Patient Care

  • Durable Medical Equipment & Medical Supplies
  • Holland, MI
  • NPI 1871741652
  NPD (past)

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

{
    "created_epoch": "1160006400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1689761439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC-845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560",
            "telephone_number": "616-391-1909",
            "fax_number": "616-391-8612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "221 MICHIGAN ST NE STE 300",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032537",
            "telephone_number": "616-391-1909",
            "fax_number": "616-391-8612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IACOBUCCI",
        "first_name": "JOHN",
        "middle_name": "J",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-05",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301047493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3397368",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Ann Marie Hyland, LMSW
• Senora Hyland
• Samantha Marie-Balaj Hyzer, NP
• HZ Chiro GR PC
• I Care Optics LLC
• Miranda Iacopelli, NP
• Phaedra Iafano, DC
• Shannon Kathleen Iakiri, N.P.
• Katherine Iandoli, OTR
• Karina Ibarra Gomez

• Plastic and Reconstructive Surgery Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.