Individual provider Active NPI

Kimberly Ann Boes, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1336779891
Registry record updated Mar 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601009836 Issued in MI
Practice address
4055 Cascade Rd SE
Grand Rapids, MI 49546-2149
Phone
(616) 252-3630
NPI assigned
Jan 23, 2020
Last updated
Mar 9, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601009836 MI Primary
Medical Physician Assistant 363AM0700X

Addresses

Primary practice location

4055 Cascade Rd SE
Grand Rapids, MI 49546-2149

Mailing address

4055 Cascade Rd SE
Grand Rapids, MI 49546-2149

Other practice location 1

5900 Byron Center Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-7200

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
I20200215000203 MI Practitioner - Physician Assistant 6204262090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Metropolitan HospitalGroup PAC ID 5597651836, 421 clinicians

Practice addresses (Care Compare)

4055 Cascade Rd SE
Grand Rapids, MI 49546-2149

5900 Byron Ctr Ave
Wyoming, MI 49519-9606

5900 Byron Ctr Ave SW
Wyoming, MI 49519-9606
Phone (616) 252-3243

5900 Byron Ctr Swave
Wyoming, MI 49519-9606
Phone (616) 252-7200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601009836MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Hospital CurrentSince Mar 1, 2023 Accepting new patients
Metropolitan Hospital CurrentSince Mar 1, 2023 Accepting new patients
Metropolitan Hospital Past Accepting new patients
Metropolitan Hospital Past Accepting new patients

Locations

4055 Cascade Rd SE
Grand Rapids, MI 49546
Phone (616) 252-4410

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

5950 Metro Way SW
Wyoming, MI 49519
Phone (616) 252-8100

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1579737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678320000000",
    "number": "1336779891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462149"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4055 CASCADE RD SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495462149",
            "telephone_number": "616-252-3630"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5900 Byron Center Ave SW",
            "address_purpose": "LOCATION",
            "city": "Wyoming",
            "state": "MI",
            "postal_code": "495199606",
            "country_code": "US",
            "telephone_number": "616-252-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOES",
        "first_name": "KIMBERLY",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-23",
        "last_updated": "2023-03-09",
        "certification_date": "2023-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009836",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.