Active NPI
David Craig Boersma, PHD
- Forensic Psychologist
- Grand Rapids, MI
National Provider Identifier
1942535323
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- 6301006074
- Practice address
- 703 Ball Ave NE
Grand Rapids, MI 49503-1307 - Phone
- (616) 774-0207
- Fax
- (616) 632-6361
- NPI assigned
- Oct 2, 2009
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | 6301006074 | MI | Primary |
Addresses
Primary practice location
703 Ball Ave NE
Grand Rapids, MI 49503-1307
Mailing address
703 Ball Ave NE
Grand Rapids, MI 49503-1307
Phone (616) 774-0207
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 |
|---|---|---|---|
| 6301006074 | MI | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254441600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254441600000",
"number": "1942535323",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "703 BALL AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031307",
"telephone_number": "616-774-0207",
"fax_number": "616-632-6361"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "703 BALL AVE NE",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495031307",
"telephone_number": "616-774-0207",
"fax_number": "616-632-6361"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOERSMA",
"first_name": "DAVID",
"middle_name": "CRAIG",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-02",
"last_updated": "2009-10-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "MI",
"license": "6301006074",
"primary": true
}
],
"identifiers": [],
"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 Oct 2, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.