Jack R. Roossien Jr., M.D.P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301050437 Issued in MI

Legal business name

JACK R. ROOSSIEN JR., M.D.P.C.

Practice address

15151 Stanton St
Suite a
West Olive, MI 49460-8543

Phone

(616) 296-1020

Fax

(616) 296-1030

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jack Richard Roossien Jr., M.D.

Title

President

Phone

(616) 296-1020

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211846400000",
    "number": "1740406982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15151 STANTON ST",
            "address_2": "SUITE A",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494608543",
            "telephone_number": "616-296-1020",
            "fax_number": "616-296-1030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15151 STANTON ST",
            "address_2": "SUITE A",
            "city": "WEST OLIVE",
            "state": "MI",
            "postal_code": "494608543",
            "telephone_number": "616-296-1020",
            "fax_number": "616-296-1030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JACK R. ROOSSIEN JR., M.D.P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2008-05-27",
        "status": "A",
        "authorized_official_last_name": "ROOSSIEN",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-296-1020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301050437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "ON13120",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4214810",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in West Olive, MI
• Providers in West Olive, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2008; 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.