Haven Spine & Pain Center PLLC
NPI 1053901314ActiveOrganization· Pain Medicine, Interventional Pain Medicine· Grand Rapids, MI
Pain Medicine, Interventional Pain Medicine in Grand Rapids, Michigan, registered in NPPES in January 2021. The authorized official on file is Jack Dillon, Executive Director. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1053901314 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jan 21, 2021 |
| Last updated in NPPES | Dec 9, 2021 |
| Certified by provider | Dec 9, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Pain Medicine, Interventional Pain Medicine Primary | 208VP0014X | — | — |
| Anesthesiology, Pain Medicine | 207LP2900X | — | — |
| Pain Medicine, Pain Medicine | 208VP0000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (MI) |
|---|
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