Individual provider Active NPI

Michelle J Andersen, C.F.N.P.

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1386673853
Registry record updated Apr 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704217093 Issued in MI
Practice address
3264 N Evergreen Dr NE
Grand Rapids, MI 49525-9746
Phone
(616) 363-7272
Fax
(616) 361-5828
NPI assigned
Jun 30, 2006
Last updated
Apr 5, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2021

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 4704217093 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) 363-7272

Other identifiers 2

IdentifierTypeStateIssuer
4466209MedicaidMI
1639253784MedicaidMI

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
I20100429001083 MI Practitioner - Nurse Practitioner 1254468895 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2002
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)

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

1987 Navaho TRL
Okemos, MI 48864-2721
Phone (616) 363-7272

25044 Hadlock Dr
Novi, MI 48374-2553
Phone (616) 363-7272

300 E Warwick Dr
Alma, MI 48801-1014
Phone (616) 363-7272

3881 Baulistrol Dr
Okemos, MI 48864-3392
Phone (616) 363-7272

4280 Redbud TRL
Williamston, MI 48895-9103
Phone (616) 363-7272

7250 Delta River Dr
Lansing, MI 48906-9074
Phone (616) 363-7272

844 Washington Ave
Holland, MI 49423-7195
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

Merit-based Incentive Payment System (MIPS)

Final score
95.17 of 100Reported as group
Quality
91.34
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
82.58 of 100Reported as group
Quality
58.15
Promoting interoperability
100
Improvement activities
40
Cost
74.45

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital Family Current Accepting new patients
Memorial Hospital Family CurrentSince Feb 1, 2021 Accepting new patients
Memorial Hospital CurrentSince Feb 1, 2021 Accepting new patients

Locations

9000 Peet Rd
Chesaning, MI 48616
Phone (989) 720-2273

9099 E Lansing Rd
Ste B
Durand, MI 48429
Phone (989) 288-0400

208 N Shiawassee St
Owosso, MI 48867
Phone (989) 723-9796

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

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 8

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617580800000",
    "number": "1386673853",
    "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": "616-363-7272",
            "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": "616-363-7272",
            "fax_number": "616-361-5828"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSEN",
        "first_name": "MICHELLE",
        "middle_name": "J",
        "name_prefix": "Miss",
        "credential": "C.F.N.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2021-04-05",
        "certification_date": "2021-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704217093",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4466209",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639253784",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.