Individual provider Active NPI

Amy Renee Henne, MD

  • Family Medicine Physician
  • Jenison, MI
National Provider Identifier
1104879592
Registry record updated Dec 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301072799 Issued in MI
Practice address
7782 20TH Ave
Jenison, MI 49428-8524
Phone
(616) 685-8700
Fax
(616) 457-5567
NPI assigned
May 18, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301072799 MI Primary

Addresses

Primary practice location

7782 20TH Ave
Jenison, MI 49428-8524

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008
Phone (616) 685-1808

Other identifiers 4

IdentifierTypeStateIssuer
4311439MedicaidMI
4320797MedicaidMI
4308021MedicaidMI
4877231MedicaidMI

Other names 1

  • Amy Renee Andersen Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address ahenne26254@direct.trinity-health.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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 1

Enrollment IDStateProvider typePAC IDDetails
I20050808000451 MI Practitioner - Family Practice 6507895828 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Wayne State University School of Medicine, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians
Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians
Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Practice addresses (Care Compare)

5060 Cascade Rd
Suite a
Grand Rapids, MI 49546-3808

5060 Cascade Rd SE
Suite a
Grand Rapids, MI 49546-3808

7782 20TH Ave
Jenison, MI 49428-8524
Phone (616) 685-8700

Hospital & facility affiliations

  • Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301072799MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jul 1, 2010 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health Physicians PC Family Medicine Past Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

245 State St SE
Ste 1A
Grand Rapids, MI 49503

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250

7782 20th Ave
Jenison, MI 49428
Phone (616) 685-8700

Interoperability endpoints

  • Direct secure messaging: ahenne26254@direct.trinity-health.org

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640563200000",
    "number": "1104879592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008",
            "telephone_number": "616-685-1808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7782 20TH AVE",
            "city": "JENISON",
            "state": "MI",
            "postal_code": "494288524",
            "telephone_number": "616-685-8700",
            "fax_number": "616-457-5567"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENNE",
        "first_name": "AMY",
        "middle_name": "RENEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-18",
        "last_updated": "2021-12-27",
        "certification_date": "2021-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301072799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4311439",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4320797",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308021",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4877231",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ahenne26254@direct.trinity-health.org",
            "affiliation": "N",
            "endpointDescription": "Mercy Health Direct email address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCD",
            "address_1": "7782 20th Ave",
            "city": "Jenison",
            "state": "MI",
            "country_code": "US",
            "postal_code": "494288524",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "ANDERSEN",
            "middle_name": "RENEE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Jenison, MI

Sources for this page

Verify at the official NPI Registry.