NPIMap

Organization Active NPI

Senior Resources of West Michigan

  • Gerontology Nurse Practitioner
  • Norton Shores, MI
National Provider Identifier
1033732987
Registry record updated Apr 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
Legal business name
SENIOR RESOURCES OF WEST MICHIGAN
Practice address
560 Seminole Rd
Norton Shores, MI 49444-3720
Phone
(231) 739-5858
NPI assigned
May 27, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2022

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

Authorized official

Name
Kimberly Joan Vazquez
Title
Manager
Phone
(231) 737-4041

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LG0600X Primary

Addresses

Primary practice location

560 Seminole Rd
Norton Shores, MI 49444-3720

Mailing address

560 Seminole Rd
Norton Shores, MI 49444-3720
Phone (231) 737-4041

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160408001868 MI Part B Supplier - Clinic/Group Practice 7315245222 Receives reassigned benefits from 11 practitioners
1 other NPI on this enrollment
Practice locations: Norton Shores, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Senior Resources of West Michigan2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/20787/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir4.healow.com/fhir/r4/GGGFDD

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650240000000",
    "number": "1033732987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "560 SEMINOLE RD",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494443720",
            "telephone_number": "231-737-4041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "560 SEMINOLE RD",
            "city": "NORTON SHORES",
            "state": "MI",
            "postal_code": "494443720",
            "telephone_number": "231-739-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SENIOR RESOURCES OF WEST MICHIGAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-05-27",
        "last_updated": "2022-04-18",
        "certification_date": "2022-04-18",
        "status": "A",
        "authorized_official_last_name": "VAZQUEZ",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "JOAN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "231-737-4041"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Gerontology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norton Shores, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.