Individual provider Active NPI

Megan Amber Deboer, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1447810569
Registry record updated Feb 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704302496 Issued in MI
Practice address
260 Jefferson Ave SE Ste 221
Grand Rapids, MI 49503-4597
Phone
(616) 685-5420
Fax
(616) 685-8943
NPI assigned
Jun 20, 2019
Last updated
Feb 20, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704302495 MI
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704302496 MI Primary

Addresses

Primary practice location

260 Jefferson Ave SE Ste 221
Grand Rapids, MI 49503-4597

Mailing address

PO Box 776974
Chicago, IL 60677-6974
Phone (800) 494-5797

Other practice location 1

6050 Northland Dr NE
Rockford, MI 49341-9256
Phone (616) 685-8350

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
I20190805001090 MI Practitioner - Nurse Practitioner 0840527511 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

10047 Crossroad CT SE
Caledonia, MI 49316-7316
Phone (616) 685-8850

260 Jefferson Ave SE
Suite 115
Grand Rapids, MI 49503-4597
Phone (616) 685-2663

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704302496MIMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Jul 25, 2019 Accepting new patients
Advantage Health/Saint Mary's Medical Group CurrentSince Jul 25, 2019 Accepting new patients
Advantage Health Saint Mary's Medical Group PastSince Feb 25, 2024 Accepting new patients

Locations

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

6050 Northland Dr NE
Ste 200
Rockford, MI 49341
Phone (616) 685-8350

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708387200000",
    "number": "1447810569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 776974",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606776974",
            "telephone_number": "800-494-5797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "260 JEFFERSON AVE SE STE 221",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034597",
            "telephone_number": "616-685-5420",
            "fax_number": "616-685-8943"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6050 Northland Dr NE",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "MI",
            "postal_code": "493419256",
            "country_code": "US",
            "telephone_number": "616-685-8350",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DEBOER",
        "first_name": "MEGAN",
        "middle_name": "AMBER",
        "name_prefix": "Mrs.",
        "credential": "PMHNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2024-02-20",
        "certification_date": "2024-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704302495",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704302496",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.