Individual provider Active NPI

Maurice Ashley Sampedro, D.C.

  • Chiropractor
  • Kentwood, MI
National Provider Identifier
1942289525
Registry record updated Mar 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
2301009095 Issued in MI
Practice address
5260 Kalamazoo Ave SE
Kentwood, MI 49508-6131
Phone
(616) 827-2350
NPI assigned
Jan 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 2301009095 MI Primary

Addresses

Primary practice location

5260 Kalamazoo Ave SE
Kentwood, MI 49508-6131

Mailing address

5260 Kalamazoo Ave SE
Kentwood, MI 49508-6131
Phone (616) 581-7119

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110718000472 MI Practitioner - Chiropractic 7214105287 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1145 Washington Ave
Suite D
Holland, MI 49423-5296
Phone (616) 396-9940

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2301009095MIMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Good Life Chiropractic Inc. Chiropractor CurrentSince Jun 23, 2011 Accepting new patients
Natural Choice Chiropractic LLC Chiropractor PastSince Jan 9, 2002 Accepting new patients

Locations

1145 Washington Ave
Ste D
Holland, MI 49423
Phone (616) 396-9940

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1137024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205280000000",
    "number": "1942289525",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5260 KALAMAZOO AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086131",
            "telephone_number": "616-581-7119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5260 KALAMAZOO AVE SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495086131",
            "telephone_number": "616-827-2350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAMPEDRO",
        "first_name": "MAURICE",
        "middle_name": "ASHLEY",
        "name_prefix": "Dr.",
        "credential": "D.C.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-12",
        "last_updated": "2008-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "MI",
            "license": "2301009095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2008; 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.