Individual provider Active NPI

Rebecca Johnson, NP

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1245882703
Registry record updated Jun 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704313199 Issued in MI
Practice address
1959 E Paris Ave SE
Grand Rapids, MI 49546-6272
Phone
(616) 808-2695
Fax
(616) 808-2697
NPI assigned
Jul 15, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704313199 MI Primary

Addresses

Primary practice location

1959 E Paris Ave SE
Grand Rapids, MI 49546-6272

Mailing address

1959 E Paris Ave SE
Grand Rapids, MI 49546-6272
Phone (616) 808-2695

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
I20200107002720 MI Practitioner - Nurse Practitioner 1456785013 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Age Management of West Michigan PCGroup PAC ID 2466686290, 23 clinicians

Practice addresses (Care Compare)

1959 E Paris Ave SE
Grand Rapids, MI 49546-6272
Phone (616) 808-2695

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704313199MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital CurrentSince Feb 3, 2020 Accepting new patients
Age Management of West Michigan PC CurrentSince Dec 16, 2024 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Feb 1, 2021 Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Feb 1, 2021 Accepting new patients
Saint Mary'S Health Services PastSince Apr 25, 2021 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

1959 East Paris Ave SE
Grand Rapids, MI 49546
Phone (616) 285-3700

801 Broadway Ave NW
Ste 105
Grand Rapids, MI 49504
Phone (616) 685-7500

7686 Georgetown Center Dr
Jenison, MI 49428
Phone (616) 252-8600

5900 Byron Center Ave SW
Wyoming, MI 49519
Phone (616) 252-3243

Interoperability endpoints

  • Direct secure messaging: rveneklase28943@direct.trinity-health.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1563148800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1781740800000",
    "number": "1245882703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1959 E PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466272",
            "telephone_number": "616-808-2695",
            "fax_number": "616-808-2697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1959 E PARIS AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495466272",
            "telephone_number": "616-808-2695",
            "fax_number": "616-808-2697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "REBECCA",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-15",
        "last_updated": "2026-06-18",
        "certification_date": "2026-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704313199",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.