Individual provider Active NPI

Martin J Waalkes

  • Clinical Psychologist
  • Grand Rapids, MI
National Provider Identifier
1982811220
Registry record updated Mar 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
6301007258 Issued in MI
Practice address
1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336
Phone
(616) 940-0040
NPI assigned
May 17, 2007
Last updated
Mar 29, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 6301007258 MI Primary

Addresses

Primary practice location

1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336

Mailing address

1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336
Phone (616) 940-0040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120201000400 MI Practitioner - Clinical Psychologist 7517124621 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hope Network - Rehabilitation ServicesGroup PAC ID 9234231440, 23 clinicians

Practice addresses (Care Compare)

1490 E Beltline Ave SE
Grand Rapids, MI 49506-4336
Phone (616) 940-0040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Hope Network - Rehabilitation Services Clinical CurrentSince Dec 1, 2011 Accepting new patients

Locations

2700 E Lansing Dr
East Lansing, MI 48823
Phone (616) 332-1616

2701 E Lansing Dr
East Lansing, MI 48823
Phone 5173321616 ext. 241

2711 E Lansing Dr
East Lansing, MI 48823
Phone (517) 332-6932

2775 E Lansing Dr
East Lansing, MI 48823

1490 E Beltline Ave SE
Grand Rapids, MI 49506

5990 Venture Park Dr
Kalamazoo, MI 49009
Phone (269) 492-7842

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1179360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1301356800000",
    "number": "1982811220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1490 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064336",
            "telephone_number": "616-940-0040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1490 E BELTLINE AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064336",
            "telephone_number": "616-940-0040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAALKES",
        "first_name": "MARTIN",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-17",
        "last_updated": "2011-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301007258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.