Sandra Dejong
Individual provider Active NPI Nurse Practitioner · Richland, MI
NPI 1447360433 · NPPES record last updated Mar 22, 2023
Key facts
- NPI
- 1447360433
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 4704214378 (MI)
- Practice address
- 8906 M 89
Richland, MI 49083 - Phone
- (269) 286-7130
- Fax
- (269) 286-7131
- NPI assigned
- Aug 30, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051021000534 | MI | Practitioner - Nurse Practitioner | 5496771107 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704214378 | MI | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ascension Medical Group Promed | Current | Accepting new patients | |
| Promed Healthcare | Current |
Accepting new patients | |
| Ascension Medical Group Promed | Current |
Accepting new patients |
Locations
1701 Gull Rd
Kalamazoo, MI 49048
Phone (269) 226-2550
5943 Stadium Dr
Ste 3
Kalamazoo, MI 49009
Phone (269) 226-8315
7901 Angling Rd
Portage, MI 49024
Phone (269) 324-8405
7901 Angling Rd
Ste B-201
Portage, MI 49024
Phone (269) 324-8600
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704214378 | MI | Yes |
Addresses
Primary practice location
8906 M 89
Richland, MI 49083
Mailing address
601 John St # 42
Kalamazoo, MI 49007-5341
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | direct@direct.bronsonhg.org | Direct | Bronson Healthcare Group |
Other providers in Richland, MI
- Compass Physical Therapy Specialists
- Comprehensive Psychological and Assessment Services, LLC
- Jason Michael Corradini
- Cheryl Czerney
- Brianne Nicole Deboer
- Emily E Derhammer
- Maribel Xiomara Diaz-Munoz-Laforge
- Ashley Elizabeth Diehl
- Linda Dolbee
- Paul Joseph Ellis
All providers in Richland, MI · Nurse Practitioner in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.