Unknown Individual – Family Nurse Practitioner, NPI 1164446738
Family Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
Loading map...
Provider Addresses for Unknown Individual
5800 FOREMOST DR SE STE 300
GRAND RAPIDS, MI 495467062
Phone: (616) 954-9800
Type: Mailing
12460, Riley Street, Zeeland, Holland Charter Township, Ottawa County, Michigan, 49424, United States
HOLLAND, MI 494248217
Phone: (616) 399-6500
Fax: (616) 399-1908
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
Loading prescription activity...
Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $240.
Total Amount is formed as General ($240) + Research ($0) + Ownership ($0) = $240.
Last reported payment date: 2023-09-12 • Largest payer in this snapshot: Pharmacyclics LLC, an AbbVie Company ($172).
Total Amount
$240
General + Research + Ownership
Payments
10
Total payment records
General Amount
$240
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-09-12
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Pharmacyclics LLC, an AbbVie Company | $172 |
| Boston Scientific Corporation | $43 |
| Eisai Inc. | $25 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2005-05-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20050504000457 | I | Nurse Practitioner | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 49546)
Loading plans...
Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | MI | |
| Medical Oncology | MI | |
| Nurse Practitioner | MI | |
| Hematology/Oncology, Internal Medicine | MI | |
| Physician Assistant | MI | |
| - | MI | |
| - | MI | |
| - | MI | |
| Physician Assistant | MI | |
| H E M A T O L O G Y/ O N C O L O G Y | MI |
Reviews
All reviews are moderated before publication. Reviews reflect users' opinions; we do not verify the accuracy of individual reviews.
No reviews yet. Be the first to share your experience — your opinion helps families compare providers.