Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jack Daniel Degroot, PA-C

Individual provider Physician Assistant · NPI 1982950960

Jack Daniel Degroot, PA-C is a Physician Assistant in Grand Rapids, Michigan. Licensed in Michigan. Registered with an NPI since 2012.

Licensed in
MI
In the registry since
2012
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

1545 68th St SE Ste 100
Grand Rapids, MI 49508-7896
Phone: (616) 267-7881
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5601006401 (MI)

Record details

NPI number1982950960
Entity typeIndividual (Type 1)
GenderMale
Credentials PA-C
Sole proprietorNo
NPI enumeratedJuly 27, 2012
Last updated in NPPESFebruary 14, 2022
Certification dateFebruary 14, 2022

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