NPIMap

Organization Active NPI

Pine Rest Christian Mental Health Services

  • Professional Counselor
  • Grand Rapids, MI
National Provider Identifier
1386015683
Registry record updated Nov 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
PINE REST CHRISTIAN MENTAL HEALTH SERVICES
Practice address
300 68TH St SE
Grand Rapids, MI 49548-6927
Phone
(616) 281-6372
Fax
(616) 281-6459
NPI assigned
Oct 13, 2015
Last updated
Nov 4, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2020

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

Authorized official

Name
Diane Fennema
Title
Managed Care Administrator
Phone
(616) 281-6372

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X MI Primary

Addresses

Primary practice location

300 68TH St SE
Grand Rapids, MI 49548-6927

Mailing address

300 68TH St SE
Grand Rapids, MI 49548-6927
Phone (616) 281-6372

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040213000149 MI Part B Supplier - Clinic/Group Practice 4981506508 Receives reassigned benefits from 135 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kalamazoo, MI; Zeeland, MI; Traverse City, MI; Spring Lake, MI; Portage, MI; Holland, MI; Hastings, MI; Grandville, MI…

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Pine Rest Christ Ho42 organizations share this tax ID, including this one

Other organizations with this tax ID 41

Organizations that report the same tax identification number in the National Provider Directory.

View all 41

Locations (25 of 28)

5128 Meredith Dr
Des Moines, IA 50310
Phone (515) 669-0142

412 Jefferson St
Pella, IA 50219
Phone (515) 628-9599

1310 Wisconsin St
Grand Haven, MI 49417
Phone (616) 393-2190

1700 E Beltline Ave NE
Grand Rapids, MI 49525
Phone (616) 222-3720

1700 E Beltline Ave NE
#240
Grand Rapids, MI 49525
Phone (616) 364-1500

1700 E Beltline Ave NE
Ste 240
Grand Rapids, MI 49525
Phone (616) 364-1500

200 Jefferson Ave SE
#U
Grand Rapids, MI 49503
Phone (616) 685-6225

200 Jefferson Ave SE
Fl 8
Grand Rapids, MI 49503
Phone (616) 752-6611

310 Lafayette Ave SE
Grand Rapids, MI 49503
Phone (616) 685-3450

3292 N Evergreen Dr NE
#A
Grand Rapids, MI 49525
Phone (616) 365-8920

620 Century Ave SW
Grand Rapids, MI 49503
Phone (616) 242-6400

80 68th St SE
Ste 300
Grand Rapids, MI 49548
Phone (616) 292-1995

933 3 Mile Rd NW
#206
Grand Rapids, MI 49544
Phone (616) 222-3702

933 3 Mile Rd NW
Ste 206
Grand Rapids, MI 49544
Phone (616) 222-3720

4211 Parkway Place Dr SW
Grandville, MI 49418
Phone (616) 222-3700

4375 Canal St SW Ste 1
Grandville, MI 49418
Phone (616) 222-3700

4375 Canal SW Ave Ste 1
Grandville, MI 49418
Phone (616) 222-3700

4375 SW Canal Ave Ste 1
Grandville, MI 49418
Phone (616) 222-3700

1005 W Green St
#301
Hastings, MI 49058

450 Meadow Run Dr
Hastings, MI 49058
Phone (269) 948-8465

450 Meadow Run Dr
Ste 300
Hastings, MI 49058
Phone (269) 408-9158

4294 Laurel Dr
Ofc
Lake Odessa, MI 48849

1350 W Centre Ave
Ste 210
Portage, MI 49024
Phone (269) 910-7327

2627 Niles Ave
Saint Joseph, MI 49085
Phone (269) 983-1524

440 S State St
Zeeland, MI 49464
Phone (616) 741-3790

Practitioners & affiliated clinicians

Practitioners 701

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 701

NPI Registry JSON

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

{
    "created_epoch": "1444694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1604448000000",
    "number": "1386015683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-281-6372",
            "fax_number": "616-281-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 68TH ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495486927",
            "telephone_number": "616-281-6372",
            "fax_number": "616-281-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE REST CHRISTIAN MENTAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-13",
        "last_updated": "2020-11-04",
        "certification_date": "2020-11-04",
        "status": "A",
        "authorized_official_last_name": "FENNEMA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "MANAGED CARE ADMINISTRATOR",
        "authorized_official_telephone_number": "616-281-6372"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "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 Nov 4, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.