Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jake Anthony Nicholson, DO

Individual provider Vascular Surgery Physician · NPI 1467013698

Jake Anthony Nicholson, DO is a Vascular Surgery in Grand Rapids, Michigan. Qualified in 2019, 7 years ago. Practices with Spectrum Health Primary Care Partners, a 2,303-clinician group and accepts Medicare assignment. Licensed in Michigan.

Years since qualifying
7
Licensed in
MI
In the registry since
2019
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

275 Michigan St NE
Grand Rapids, MI 49503-2531
Phone: (616) 267-8700
Fax: (616) 267-8247
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Vascular Surgery Physician (primary) Taxonomy 2086S0129X · Licence 5151014043 (MI)

Record details

NPI number1467013698
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedJune 27, 2019
Last updated in NPPESJanuary 27, 2025
Certification dateJanuary 27, 2025
Mailing address100 Michigan St Ne # Mc845, Grand Rapids, MI 49503-2560

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyVASCULAR SURGERY
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Spectrum Health Primary Care Partners — 2303 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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