NPIMap

Organization Active NPI

Holland Foot and Ankle Center, PC

  • Durable Medical Equipment & Medical Supplies
  • Holland, MI
National Provider Identifier
1396282935
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
HOLLAND FOOT AND ANKLE CENTER, PC
Practice address
445 120TH Ave
Holland, MI 49424-2119
Phone
(616) 738-1300
Fax
(616) 738-0768
NPI assigned
Jan 20, 2017
Last updated
Nov 24, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
HOLLAND FOOT AND ANKLE CENTER, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

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

Authorized official

Name
Brent Van Til, DPMNPI 1225285992
Title
Owner
Phone
(616) 392-7472

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
PodiatristGroup: 193400000X SINGLE SPECIALTY GROUP 213E00000X MI
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

445 120TH Ave
Holland, MI 49424-2119

Mailing address

904 Washington Ave
Holland, MI 49423-7724
Phone (616) 392-7472

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170201000862 MI DME Supplier - Physician - Podiatry 1658265202 Practice locations: Holland, MI

Other NPIs with the same Medicare PAC ID 5

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Holland Foot Ankle Ctr PC5 organizations share this tax ID, including this one
Part of
Holland Foot Ankle Ctr PC

Other organizations with this tax ID 4

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

Locations

445 120th Ave
Holland, MI 49424
Phone (616) 738-1300

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1484870400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1637712000000",
    "number": "1396282935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 WASHINGTON AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237724",
            "telephone_number": "616-392-7472",
            "fax_number": "616-392-3327"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242119",
            "telephone_number": "616-738-1300",
            "fax_number": "616-738-0768"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLAND FOOT AND ANKLE CENTER, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HOLLAND FOOT AND ANKLE CENTER, PC",
        "enumeration_date": "2017-01-20",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A",
        "authorized_official_last_name": "VAN TIL",
        "authorized_official_first_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "616-392-7472",
        "authorized_official_credential": "DPM"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.