DR. JACK RICHARD ROOSSIEN M.D. NPI 1184610669

NPI Information

  • NPI: 1184610669
  • Provider Name: DR. JACK RICHARD ROOSSIEN, M.D.
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 15151 STANTON ST
    SUITE A
    WEST OLIVE, MI
    ZIP 49460
  • Phone: (616) 296-1020

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NPI Details

DR. Jack Richard Roossien, M.D. is a family medicine in West Olive, MI. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. DR. Jack Richard Roossien, M.D. NPI is 1184610669. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

15151 STANTON ST
SUITE A
WEST OLIVE, MI
ZIP 49460-543
Phone: (616) 296-1020
Fax: (616) 296-1030

The NPI 1184610669 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/21/2005 and was last updated on 6/7/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1207Q00000XFamily MedicineJR050437MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11184610669MEDICAIDMICHIGAN
24214810MEDICAIDMICHIGAN
3ON13120OTHERMICHIGANMEDICARE GROUP NUMBER

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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