Individual provider Active NPI

Kristi Vander Hyde, NP

  • Primary Care Nurse Practitioner
  • Dexter, MI
National Provider Identifier
1225030497
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
4704157442 Issued in MI
Practice address
7300 Dexter-Ann Arbor Rd
Dexter, MI 48130-8598
Phone
(734) 426-2796
NPI assigned
Jun 1, 2005
Last updated
Dec 31, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704157442 MI
Community Health Nurse Practitioner 363LC1500X 4704157442 MI
Primary Care Nurse Practitioner 363LP2300X 4704157442 MI Primary

Addresses

Primary practice location

7300 Dexter-Ann Arbor Rd
Dexter, MI 48130-8598

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 3

IdentifierTypeStateIssuer
104702549MedicaidMI
0860085OtherMIBCBS OF MICHIGAN
4851610MedicaidMI

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060410000191 MI Practitioner - Nurse Practitioner 6406865070 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704157442MIMDCommunity Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Regents of the University of Michigan Nurse Practitioner CurrentSince Jan 26, 2016 Accepting new patients
Regents of the University of Michigan CurrentSince Jan 26, 2016 Accepting new patients

Locations

1500 E Medical Center Dr
Ann Arbor, MI 48109
Phone (734) 936-4280

207 Fletcher St
Ann Arbor, MI 48109
Phone (734) 764-8320

3621 S State St
#700
Ann Arbor, MI 48108

400 E Eisenhower Pkwy
Ste B
Ann Arbor, MI 48108
Phone (734) 232-2600

7300 Dexter Ann Arbor Rd
Dexter, MI 48130
Phone (734) 426-2796

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451520000000",
    "number": "1225030497",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7300 DEXTER-ANN ARBOR RD",
            "city": "DEXTER",
            "state": "MI",
            "postal_code": "481308598",
            "telephone_number": "734-426-2796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER HYDE",
        "first_name": "KRISTI",
        "name_prefix": "Ms.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-01",
        "last_updated": "2015-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704157442",
            "primary": false
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Community Health",
            "state": "MI",
            "license": "4704157442",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704157442",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104702549",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "0860085",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4851610",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Dexter, MI

Sources for this page

Verify at the official NPI Registry.