Individual provider Active NPI

Kevin S Timmerman, FNP

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1356371868
Registry record updated Mar 6, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704223880 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7339
Fax
(616) 361-5828
NPI assigned
Jul 3, 2006
Last updated
Mar 6, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2015

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 4704223880 MI Primary

Addresses

Primary practice location

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746

Mailing address

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone (616) 363-7339

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
I20060216000250 MI Practitioner - Nurse Practitioner 6901811660 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Radiology Services PCGroup PAC ID 4284546516, 252 clinicians

Practice addresses (Care Compare)

Ada, MI 49301
Phone (616) 363-7272

100 Michigan Ave NE
Grand Rapids, MI 49503-2560
Phone (616) 363-7272

1104 Plymouth Ave SE
East Grand Rapids, MI 49506-6528
Phone (616) 363-7272

11751 Hastings Rd
Clarksville, MI 48815-9753
Phone (616) 363-7272

14544 Georgian Bay Dr
Holland, MI 49424-7535
Phone (616) 363-7272

1840 Wealthy St SE
Grand Rapids, MI 49506-2921
Phone (616) 363-7272

212 S Sullivan Ave
Fremont, MI 49412-1548
Phone (616) 363-7272

3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone 61636372721046

3700 Lake Birch St NE
Grand Rapids, MI 49525-8606
Phone (616) 363-7272

4055 Mont Katnich CT NE
Grand Rapids, MI 49525-3426
Phone (616) 363-7272

4900 Catamount TRL NE
C/O R. Konwinski
Ada, MI 49301-9681
Phone (616) 363-7272

5881 Stratford Glen CT SE
Grand Rapids, MI 49546-3886
Phone (616) 363-7272

602 Michigan Ave
Holland, MI 49423-4918
Phone (616) 363-7272

605 Oak St
Big Rapids, MI 49307-2048
Phone (616) 363-7272

6240 Red Pine Rd
Boyne City, MI 49712-9270
Phone (616) 363-7272

6680 Farms End Dr SE
Grand Rapids, MI 49546-6620
Phone (616) 363-7272

7702 Fase St SE
Ada, MI 49301-9431
Phone (616) 363-7272

822 Barkentine Dr
Holland, MI 49424-7807
Phone (616) 363-7272

8333 Felch St
Zeeland, MI 49464-2608
Phone (616) 363-7272

844 Washington Ave
Holland, MI 49423-7195
Phone (616) 363-7272

947 San Jose Dr SE
East Grand Rapids, MI 49506-3421
Phone (616) 363-7272

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
90.33 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704223880MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Care Specialists PC Past Accepting new patients

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.

Hospital & facility affiliations 5

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": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425600000000",
    "number": "1356371868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3264 N EVERGREEN DR NE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259746",
            "telephone_number": "616-363-7339",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMMERMAN",
        "first_name": "KEVIN",
        "middle_name": "S",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-03",
        "last_updated": "2015-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704223880",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.