Kipp Edward Rustenholtz, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

3413 Woods Edge
Okemos, MI 48864-5901

Phone

(517) 349-3303

NPI assigned

May 7, 2008

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iha Health Services CorporationGroup PAC ID 2466351440, 1,149 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Trinity Health Ann Arbor Hospital Hospital, Ann Arbor, MI, CCN 230156
• Trinity Health Livingston Hospital Hospital, Howell, MI, CCN 230069

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krustenholtz36625@direct.trinity-health.org

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.

• Iha Health Services Corporation

  • Obstetrics & Gynecology Physician
  • Canton, MI
  • NPI 1457408965
  Medicare reassignment Care Compare group
• Lansing Cardiovascular Consultants PC

  • Nuclear Cardiology Physician
  • Okemos, MI
  • NPI 1548301880
  Medicare reassignment
• Iha Health Service Corporation

  • Obstetrics & Gynecology Physician
  • Ypsilanti, MI
  • NPI 1831053701
  NPD
• Iha Health Services Corporation

  • Neurological Surgery Physician
  • Ypsilanti, MI
  • NPI 1629726179
  NPD
• Next Generation Family Practice, PLLC

  • Family Medicine Physician
  • Lansing, MI
  • NPI 1225085079

  Physician Assistant

  NPD (past)

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

• Saint Joseph Mercy Livingston Hospital

  • General Acute Care Hospital
  • Brighton, MI
  • NPI 1093748642
  Care Compare affiliation
• St Joseph Mercy Hospital

  • General Acute Care Hospital
  • Ypsilanti, MI
  • NPI 1780658443
  Care Compare affiliation

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

{
    "created_epoch": "1210118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731628800000",
    "number": "1114193356",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1147 TEAKWOOD CIR",
            "city": "HASLETT",
            "state": "MI",
            "postal_code": "488409734",
            "telephone_number": "517-339-0188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3413 WOODS EDGE",
            "city": "OKEMOS",
            "state": "MI",
            "postal_code": "488645901",
            "telephone_number": "517-349-3303"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1881 W Grand River Ave",
            "address_purpose": "LOCATION",
            "city": "Okemos",
            "state": "MI",
            "postal_code": "488641840",
            "country_code": "US",
            "telephone_number": "517-339-2100",
            "fax_number": "517-339-4620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSTENHOLTZ",
        "first_name": "KIPP",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-05-07",
        "last_updated": "2024-11-15",
        "certification_date": "2024-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dale G Rupprecht, PA
• Emily Rusch
• Sandra K Russell, DO
• Emma Russold
• Saanch Rustagi
• Lydia Rutkowski
• RX Optical Laboratories, Inc.
• Ryan J Beyea DDS PLLC
• Sabreen Ettaher Behavioral Health PLLC
• Sacred Spaces of Hope LLC

• Physician Assistant in Okemos, MI
• Providers in Okemos, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.