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HAVEN SPINE & PAIN CENTER PLLC
NPI 1053901314
Pain Medicine - Interventional Pain Medicine in Grand Rapids, MI

Active since January 21, 2021CLIA 23D2235865 · Waiver
2680 LEONARD ST NE STE 3, GRAND RAPIDS, MI 49525(616) 364-4200(616) 364-7347 Get Directions Write a Review

NPPES record last updated: December 9, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 9, 2021, Jan 21, 2021 (2 updates tracked since 2021).

About Haven Spine & Pain Center Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

HAVEN SPINE & PAIN CENTER PLLC (NPI 1053901314) is a healthcare organization registered as an interventional pain medicine in Grand Rapids, Michigan and active in the NPI registry since January 2021. The organization holds a CLIA Waiver certificate valid through September 12, 2027 and lists Jack Dillon, Executive Director, as its authorized official.

NPPES Registry Identity

NPI1053901314
Entity TypeOrganization
Primary Taxonomy208VP0014X
Legal Business NameHAVEN SPINE & PAIN CENTER PLLC
Location Address2680 LEONARD ST NE STE 3Grand Rapids, MI 49525-6902
Mailing Address2680 Leonard St Ne Ste 3Grand Rapids, MI 49525-6902 · (616) 364-4200 · Fax (616) 364-7347
Phone(616) 364-4200
Fax(616) 364-7347
Organization SubpartNo
Authorized OfficialJack DillonExecutive Director · (312) 505-1033
Enumeration DateJanuary 21, 2021
Last NPPES UpdateDecember 9, 20212 updates tracked since enumeration
NPPES CertifiedDecember 9, 2021
✔ NPI 1053901314 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPain Medicine · Interventional Pain MedicineAllopathic & Osteopathic Physicians
Taxonomy Code208VP0014X
Definition
Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment.
Also ListedAnesthesiology · Pain MedicineTaxonomy 207LP2900X
Also ListedPain Medicine · Pain MedicineTaxonomy 208VP0000X
2680 LEONARD ST NE STE 3, Grand Rapids, MI 49525
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Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Haven Spine & Pain Center Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

4

Medicare enrollment records show 4 clinicians reassign Medicare billing to Haven Spine & Pain Center PLLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 4 within 10 miles. They are listed nearest first.

Clinicians, nearest first (4)

Adam Powell, D.O.
Anesthesiology
NPI 1134460439
2680 LEONARD ST NE STE 3
Grand Rapids, MI 49525
(616) 317-7246
✔ PECOS✔ Accepts MedicareSame address
Laurena Schultz, NP
Nurse Practitioner
NPI 1154905289
2680 LEONARD ST NE STE 3
Grand Rapids, MI 49525
(616) 317-7246
✔ PECOS✔ Accepts MedicareSame address
Marc Korn, MD
Pain Management
NPI 1205253671
2680 LEONARD ST NE STE 3
Grand Rapids, MI 49525
(616) 317-7246
✔ PECOS✔ Accepts MedicareSame address
Zachary Nowak, MD
Anesthesiology
NPI 1487176665
2680 LEONARD ST NE STE 3
Grand Rapids, MI 49525
(616) 317-7246
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 23D2235865

Haven Spine + Pain · Grand Rapids, MI
Active · expires Sep 12, 2027
CLIA Number23D2235865
Laboratory TypePhysician Office
Certificate Effective DateSeptember 13, 2025
Certificate Expiration DateSeptember 12, 2027
Laboratory DirectorCaroline A. Ring
Laboratory Phone(616) 317-7246
Laboratory LocationHaven Spine + Pain2680 Leonard Street NE Suite 3, Grand Rapids, MI 49525
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Haven Spine & Pain Center PLLC's NPI number?

The NPI number for Haven Spine & Pain Center PLLC is 1053901314. It was assigned to this organization in the NPPES registry on January 21, 2021.

Where is Haven Spine & Pain Center PLLC located?

Haven Spine & Pain Center PLLC is located at 2680 Leonard St NE Ste 3, Grand Rapids, MI 49525. The listed phone number is (616) 364-4200.

What is Haven Spine & Pain Center PLLC's specialty?

The primary specialty registered for this NPI is Pain Medicine, specializing in Interventional Pain Medicine, with taxonomy code 208VP0014X.

Is Haven Spine & Pain Center PLLC enrolled in Medicare?

Yes. Haven Spine & Pain Center PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Haven Spine & Pain Center PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 4 clinicians reassign their Medicare billing to Haven Spine & Pain Center PLLC, in Anesthesiology, Nurse Practitioner and Pain Management. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Of these, 2 practice at this address and 4 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Haven Spine & Pain Center PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 23D2235865) is associated with this NPI, valid through September 12, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Haven Spine & Pain Center PLLC accept?

Health plans from Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Haven Spine & Pain Center PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Haven Spine & Pain Center PLLC was last updated on December 9, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.