Brent Tannin Tabata, MS, RD

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

973751 Issued in MI

Practice address

360 Lafayette Ave SE Ste 400
Grand Rapids, MI 49503-4677

Phone

(616) 486-6870

Fax

(616) 454-6898

NPI assigned

Mar 28, 2023

Last updated

Jun 5, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Spectrum Health Primary Care Partners

  dba Corewell Health Medical Group West Intensive Feeding

  • Pediatric Neurodevelopmental Disabilities Physician
  • Grand Rapids, MI
  • NPI 1922582196
  NPD (past)

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1685923200000",
    "number": "1922702638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "360 LAFAYETTE AVE SE STE 400",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034677",
            "telephone_number": "616-486-6870",
            "fax_number": "616-454-6898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TABATA",
        "first_name": "BRENT",
        "middle_name": "TANNIN",
        "credential": "MS, RD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-06-05",
        "certification_date": "2023-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MI",
            "license": "973751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Edward Joseph Szumowski, AU.D.
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• T-N-E Transportation Services
• Elena Christine - James Tabacaru
• Dana Tabbara, DO
• Maha Tabbara, TLLP
• Ken Taber, MSW
• Rodman Murchison Taber, M.D.
• Tabletalk Counseling LLC

• Registered Dietitian in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Registered Dietitian in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 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.

Verify at the official NPI Registry.