Individual provider Active NPI

McKensay Elisabeth Heinonen, FNP-BC

  • Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1437495967
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704245459 Issued in MI
Practice address
200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone
(616) 685-6374
Fax
(616) 685-6610
NPI assigned
Jan 3, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704245459 MI Primary

Addresses

Primary practice location

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502

Mailing address

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-6374

Other names 1

  • McKensay Elisabeth Hourtienne Former name

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
I20130412000020 MI Practitioner - Nurse Practitioner 0345486601 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

200 Jefferson Ave SE
Grand Rapids, MI 49503-4502
Phone (616) 685-5000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704245459MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary'S Medical Group Nurse Practitioner CurrentSince Aug 29, 2019 Accepting new patients
Advantage Health/Saint Mary'S Medical Group Current Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Aug 29, 2019 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

310 Jefferson Ave SE Ste 3400
Grand Rapids, MI 49503

200 Jefferson Ave SE
Grand Rapids, MI 49503
Phone (616) 685-5000

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1357171200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567036800000",
    "number": "1437495967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-6374",
            "fax_number": "616-685-6610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 JEFFERSON AVE SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034502",
            "telephone_number": "616-685-6374",
            "fax_number": "616-685-6610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEINONEN",
        "first_name": "MCKENSAY",
        "middle_name": "ELISABETH",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-03",
        "last_updated": "2019-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704245459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MCKENSAY",
            "last_name": "HOURTIENNE",
            "middle_name": "ELISABETH",
            "credential": "FNP-BC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.