Jared Lee Kooistra, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2301009263 Issued in MI

Practice address

2855 Byron Center Ave SW
Wyoming, MI 49519-2415

Phone

(616) 532-2518

Fax

(616) 532-2696

NPI assigned

Jan 3, 2007

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

Enrolled in MI

Enrollment records 1

Specialty

Chiropractic

Education

Logan College of Chiropractic, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Kooistra Chiropractic Clinic PLLCGroup PAC ID 0042472672, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/EJDADD

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.

• Kooistra Chiropractic Clinic PLLC

  • Chiropractor
  • Wyoming, MI
  • NPI 1396018446
  Medicare reassignment Care Compare group NPD
• Michigan Pain Consultants PC

  • Pain Medicine (Anesthesiology) Physician
  • Grand Rapids, MI
  • NPI 1467418574
  NPD (past)

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

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1770640211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2855 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495192415",
            "telephone_number": "616-532-2518",
            "fax_number": "616-532-2696"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2855 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495192415",
            "telephone_number": "616-532-2518",
            "fax_number": "616-532-2696"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOISTRA",
        "first_name": "JARED",
        "middle_name": "LEE",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009263",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Hope Kooienga
• Jack A Kooienga, APRN
• Kooistra Chiropractic Clinic PLLC
• Charles Scott Kooistra, DC
• Gerald B Kooistra, DC
• Laura Kooy
• Korte Endodontics
• Mark Kosten, NP
• Donique Kosters, LLMSW
• Nathan Alvin Kotecki, LLBSW

• Chiropractor in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Chiropractor in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.