Active NPI
Kelsey Deroos
- Behavior Analyst
- Holland, MI
National Provider Identifier
1124500384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 11172 Adams St
Holland, MI 49423-9163 - Phone
- (616) 942-2522
- NPI assigned
- Sep 5, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | Primary |
Addresses
Primary practice location
11172 Adams St
Holland, MI 49423-9163
Mailing address
8527 88TH Ave
Zeeland, MI 49464-9472
Phone (616) 953-9516
Other practice location 1
1115 Ball Ave NE
Grand Rapids, MI 49505-5904
Phone (616) 456-6571
Other practice location 2
11172 Adams St
Holland, MI 49423-9163
Phone (616) 301-8000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hope Network Behavioral Health Services | Social Worker | Past | Accepting new patients |
| Hope Network Behavioral Health Services | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Mental Illness Community Based Residential Treatment Facility
- Nunica, MI
- NPI 1043295934
Social Worker
-
- Child & Adolescent Psychiatry Physician
- Grand Rapids, MI
- NPI 1104128602
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686787200000",
"number": "1124500384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8527 88TH AVE",
"city": "ZEELAND",
"state": "MI",
"postal_code": "494649472",
"telephone_number": "616-953-9516"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11172 ADAMS ST",
"city": "HOLLAND",
"state": "MI",
"postal_code": "494239163",
"telephone_number": "616-942-2522"
}
],
"practiceLocations": [
{
"address_1": "1115 Ball Ave NE",
"address_purpose": "LOCATION",
"city": "Grand Rapids",
"state": "MI",
"postal_code": "495055904",
"country_code": "US",
"telephone_number": "616-456-6571",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "11172 Adams St",
"address_purpose": "LOCATION",
"city": "Holland",
"state": "MI",
"postal_code": "494239163",
"country_code": "US",
"telephone_number": "616-301-8000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DEROOS",
"first_name": "KELSEY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-05",
"last_updated": "2023-06-15",
"certification_date": "2023-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Holland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.