Maria E Dimusto-Poortenga, MD

Primary specialty

Neonatal-Perinatal Medicine PhysicianTaxonomy code 2080N0001X

License

4301068818 Issued in MI

Practice address

200 Jefferson Ave SE
Nicu
Grand Rapids, MI 49503-4502

Phone

(616) 752-6554

NPI assigned

Jul 7, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Other identifiers 3

Other names 1

• Mariel Elizabeth Dimustopoortenga Other name

Medicare fee-for-service enrollment

Enrolled in MI, IA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ascension Medical Group Promed

  • Family Medicine Physician
  • Portage, MI
  • NPI 1497709869

  Pediatrics

  Medicare reassignment NPD
• Genesis Health System

  • Clinic/Center
  • Bettendorf, IA
  • NPI 1497772008
  Medicare reassignment
• Ascension Medical Group Promed

  • Internal Medicine Physician
  • Kalamazoo, MI
  • NPI 1720009954

  Neonatal-Perinatal Medicine

  NPD
• Promed Healthcare

  • Rural Health Clinic/Center
  • Plainwell, MI
  • NPI 1487708830
  NPD
• Genesis Health System

  • Family Medicine Physician
  • Davenport, IA
  • NPI 1477654945

  Pediatrics

  NPD
• Genesis Health System

  • Critical Access Hospital
  • De Witt, IA
  • NPI 1649368523
  NPD
• Genesis Health System

  • General Acute Care Hospital
  • Davenport, IA
  • NPI 1972542264
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701734400000",
    "number": "1013940980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034328",
            "fax_number": "616-913-1818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "address_2": "NICU",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-752-6554"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1000 McKinley Park Dr",
            "address_purpose": "LOCATION",
            "city": "Marion",
            "state": "OH",
            "postal_code": "433026399",
            "country_code": "US",
            "telephone_number": "740-383-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DIMUSTO-POORTENGA",
        "first_name": "MARIA",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-07",
        "last_updated": "2023-12-05",
        "certification_date": "2023-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301068818",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "OH",
            "license": "35C001071",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MI",
            "license": "1013940980",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "FL",
            "license": "ME141884",
            "primary": false
        },
        {
            "code": "2080N0001X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Neonatal-Perinatal Medicine",
            "state": "MI",
            "license": "4301068818",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031359",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4120849",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4877886",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIEL",
            "last_name": "DIMUSTOPOORTENGA",
            "middle_name": "ELIZABETH",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Hannah Elizabeth Dilly
• Raven Dilworth
• Norillah Diman
• Eugene Dimenstein
• Emily Rose Dimperio, LCSW
• Robert G Dinallo, PHD LPC
• Lillia Dincheva-Vogel
• Brent James Dingman, DDS
• Chelsea Paige Dingman, PT, DPT
• Nga Nguyet Dinh, M.D.

• Neonatal-Perinatal Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Neonatal-Perinatal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.