Nicole Kooiker, D.D.S

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901018147 Issued in MI

Practice address

751 Lafayette Ave NE
Grand Rapids, MI 49503-1628

Phone

(616) 742-9941

NPI assigned

Aug 15, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 3

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: nicole.kooiker.p1@direct.cherryhealth.nextgenshare.com

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

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1346353471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 CHERRY ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034748",
            "telephone_number": "616-235-7280",
            "fax_number": "616-752-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "751 LAFAYETTE AVE NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495031628",
            "telephone_number": "616-742-9941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOIKER",
        "first_name": "NICOLE",
        "credential": "D.D.S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018147",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "D181470",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4525391",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4379794",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Kooi
• William Blake Kooi, MA, LPC, QIDP
• Christopher Kooienga
• Ross Kooienga, PA-C
• Kevin Kooiker, D.D.S
• Payton Jon Kooiker, DO
• Joshua S Kooistra, DO
• Melissa A Kooistra, PA
• Swanee Kooistra, RN
• Kool Counseling, LLC

• General Practice Dentistry in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.