John David Bruinsma, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

29011013583 Issued in MI

Practice address

414 Plymouth Ave., NE
Grand Rapids, MI 49505-6038

Phone

(616) 655-1650

Fax

(616) 655-1678

NPI assigned

Oct 30, 2007

Last updated

Mar 1, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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

• Beckwith Family Dental Care PLC

  • Dentist
  • Grand Rapids, MI
  • NPI 1366518391
  NPD (past)
• Daniel W Grode PLLC

  dba Grand City Dentistry

  • Dental Clinic/Center
  • Grand Rapids, MI
  • NPI 1588290951
  NPD (past)

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

{
    "created_epoch": "1193702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646092800000",
    "number": "1114106994",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 PLYMOUTH AVE., NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495056038",
            "telephone_number": "616-655-1650",
            "fax_number": "616-655-1678"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 PLYMOUTH AVE., NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495056038",
            "telephone_number": "616-655-1650",
            "fax_number": "616-655-1678"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUINSMA",
        "first_name": "JOHN",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-10-30",
        "last_updated": "2022-03-01",
        "certification_date": "2022-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "29011013583",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Bruin
• Stefanie Bruinooge
• Anna E Bruins-Campbell, MD
• Benjamin J Bruinsma, M.D.
• Chelsea Diane Bruinsma, MA
• Caitlin Brummel, BSW, QIDP
• Katrina Ann Brummel, PA-C
• Rebecca Marie Brummel, BS
• Scott R Brundage, MD
• Debra Christine Brunette, RD

• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2022; 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.