Sally Kliphuis, MD
Individual provider Active NPI Family Medicine Physician · Walker, MI
NPI 1114979929 · NPPES record last updated Jun 29, 2009
Key facts
- NPI
- 1114979929
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 4301047638 (MI)
- Practice address
- 933 3 Mile Rd NW
Suite 210
Walker, MI 49544-1673 - Phone
- (616) 685-8150
- Fax
- (616) 785-0238
- NPI assigned
- May 17, 2006
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Michigan State University College of Human Medicine, 1983
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Advantage Health/Saint Mary'S Medical Group
Practice addresses (Care Compare)
10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850
933 3 Mile Rd NW
Suite 210
Grand Rapids, MI 49544-1673
Phone (616) 685-8150
Hospital & facility affiliations
- Mercy Health Saint Mary'S
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060907000216 | MI | Practitioner - Family Practice | 8022012996 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advantage Health/Saint Mary'S Medical Group | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Current |
Accepting new patients | |
| Advantage Health Saint Mary'S Medical Group | Past | 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
200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000
245 State St SE
Grand Rapids, MI 49503
Phone (616) 685-1808
245 State St SE
Ste 1A
Grand Rapids, MI 49503
3380 44th St SW
Grandville, MI 49418
Phone (616) 685-8250
933 3 Mile Rd NW
Ste 210
Walker, MI 49544
Phone (616) 685-7985
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 4301047638 | MI | Yes |
Addresses
Primary practice location
933 3 Mile Rd NW
Suite 210
Walker, MI 49544-1673
Mailing address
245 State St SE
Grand Rapids, MI 49503-4328
Phone (616) 685-1808
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3415690 | Medicaid | MI | |
| 3192431 | Medicaid | MI | |
| 4186107 | Medicaid | MI | |
| 4186054 | Medicaid | MI | |
| 4168136 | Medicaid | MI |
Other providers in Walker, MI
- Diane Marie Johnston
- Laura Jones
- Aimee Rae Kalczuk
- Kingsbury Place
- Jillian L Klatt
- Faith Lynne Kohley
- Erika Kryger
- Laura E Kuipers
- Shannon Kathleen Leikert
- Lifetime Dental Care of Michigan, P.C.
All providers in Walker, MI · Family Medicine Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.