NPIMap

Organization Active NPI

Active Brace and Limb LLC

  • Prosthetic/Orthotic Supplier
  • Petoskey, MI
National Provider Identifier
1700937836
Registry record updated Dec 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
ACTIVE BRACE AND LIMB LLC
Practice address
2780 Charlevoix Ave
Petoskey, MI 49770-8058
Phone
(231) 487-0998
NPI assigned
Jan 16, 2007
Last updated
Dec 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2013

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

Authorized official

Name
Jerry Allen Pierce, CO
Title
Co Owner
Phone
(231) 487-0998

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Customized Equipment (DME) 332BC3200X
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

2780 Charlevoix Ave
Petoskey, MI 49770-8058

Mailing address

5123 N Royal Dr
Traverse City, MI 49684-9201
Phone (231) 932-8702

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930093652 MI DME Supplier - Orthotic PersonnelDME Supplier - Medical Supply Company With Pedorthic PersonnelDME Supplier - Pedorthic PersonnelDME Supplier - Prosthetic PersonnelDME Supplier - Medical Supply Company With Prosthetic PersonnelDME Supplier - Medical Supply Company With Orthotic PersonnelDME Supplier - Medical Supply Company With Orthotic-Prosthetic 7416169222 Practice locations: Petoskey, MI

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Active Brace and Limb2780 Charlevoix Ave, Petoskey, MI 49770-9784(231) 487-0998 Heat & Cold Applications|Canes and/or Crutches|Orthoses: Custom Fabricated|Orthoses: Prefabricated (Non-Custom Fabricated)|Orthoses: Off-The-Shelf|Breast Prostheses and/or Accessories|Limb Prostheses|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Accepts assignmentParticipating since Dec 10, 2001

National Provider Directory

National Provider Directory
Tax ID family
Active Brace and Limb LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5123 N Royal Dr
Traverse City, MI 49684
Phone (231) 929-8383

NPI Registry JSON

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387324800000",
    "number": "1700937836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5123 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849201",
            "telephone_number": "231-932-8702",
            "fax_number": "231-932-8702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2780 CHARLEVOIX AVE",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497708058",
            "telephone_number": "231-487-0998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACTIVE BRACE AND LIMB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-16",
        "last_updated": "2013-12-18",
        "status": "A",
        "authorized_official_last_name": "PIERCE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CO OWNER",
        "authorized_official_telephone_number": "231-487-0998",
        "authorized_official_credential": "CO"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.