Active NPI
Brian Matthew Kreisman, PHD
- Audiologist
- Grand Rapids, MI
National Provider Identifier
1780321679
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- License
- 1601000622
- Practice address
- 2907 Breton Rd SE
Grand Rapids, MI 49512-1745 - Phone
- (616) 914-2020
- NPI assigned
- May 12, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Audiologist | 231H00000X | 1601000622 | MI | Primary |
Addresses
Primary practice location
2907 Breton Rd SE
Grand Rapids, MI 49512-1745
Mailing address
2848 Belleglade CT SE
Grand Rapids, MI 49546-8011
Phone (616) 914-2020
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1601000622 | Other | MI | STATE OF MICHIGAN AUDIOLOGY LICENSE |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1601000622 | MI | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1652313600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1690675200000",
"number": "1780321679",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2848 BELLEGLADE CT SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495468011",
"telephone_number": "616-914-2020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2907 BRETON RD SE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495121745",
"telephone_number": "616-914-2020"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KREISMAN",
"first_name": "BRIAN",
"middle_name": "MATTHEW",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-12",
"last_updated": "2023-07-30",
"certification_date": "2023-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": "MI",
"license": "1601000622",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MICHIGAN AUDIOLOGY LICENSE",
"identifier": "1601000622",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.