Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Jason Dipman, AA-C

Individual provider Anesthesiologist Assistant · NPI 1053694976

Jason Dipman, AA-C is an Anesthesiology Assistant in Grand Rapids, Michigan. Qualified in 2011, 15 years ago. Practices as a sole proprietor and works from 2 locations. Licensed in Michigan and Missouri.

Years since qualifying
15
Licensed in
MI, MO
In the registry since
2011
Specialties on file
2
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Practice location Address checks out

100 Michigan St NE
Grand Rapids, MI 49503
Phone: (616) 364-4200
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 3635 Vista Ave Ste 112, Saint Louis, MO 63110-2539 — (314) 577-8077

Specialties & licences

Anesthesiologist Assistant (primary) Taxonomy 367H00000X · Licence 1227 (MI)
Specialist Taxonomy 174400000X · Licence 2011032475 (MO)

Record details

NPI number1053694976
Entity typeIndividual (Type 1)
GenderMale
Credentials AA-C
Sole proprietorYes
NPI enumeratedSeptember 27, 2011
Last updated in NPPESDecember 13, 2018
Mailing address3333 Evergreen Dr Ne, Grand Rapids, MI 49525-9493

Medicare enrollment

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

Medicare specialtyANESTHESIOLOGY ASSISTANT
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Accepts Medicare assignment Not indicated

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