Individual provider Active NPI

Jennifer L Van Zee, M.D.

  • Pediatrics Physician
  • Grand Rapids, MI
National Provider Identifier
1316047830
Registry record updated Dec 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4301072311 Issued in MI
Practice address
710 Kenmoor Ave SE
Suite 110
Grand Rapids, MI 49546-2379
Phone
(616) 949-6112
Fax
(616) 949-8530
NPI assigned
Sep 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4301072311 MI Primary

Addresses

Primary practice location

710 Kenmoor Ave SE
Suite 110
Grand Rapids, MI 49546-2379

Mailing address

721 Kenmoor Ave SE
Grand Rapids, MI 49546-2306
Phone (616) 949-6112

Other practice location 1

1865 Georgetown Center Dr
Jenison, MI 49428-7123
Phone (616) 457-3510

Other identifiers 1

IdentifierTypeStateIssuer
4308961MedicaidMI

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301072311MIMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Western Michigan Pediatrics, PC Pediatrics PastSince Dec 18, 2022 Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670889600000",
    "number": "1316047830",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "721 KENMOOR AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462306",
            "telephone_number": "616-949-6112",
            "fax_number": "616-949-8530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 KENMOOR AVE SE",
            "address_2": "SUITE 110",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462379",
            "telephone_number": "616-949-6112",
            "fax_number": "616-949-8530"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1865 Georgetown Center Dr",
            "address_purpose": "LOCATION",
            "city": "Jenison",
            "state": "MI",
            "postal_code": "494287123",
            "country_code": "US",
            "telephone_number": "616-457-3510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VAN ZEE",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-24",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "4301072311",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4308961",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.