NPIMap

Individual provider Active NPI

Kathryn Joy Pleune, PA-C

  • Physician Assistant
  • Grand Rapids, MI
National Provider Identifier
1467426122
Registry record updated Feb 1, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601003816 Issued in MI
Practice address
1000 East Paris Ave SE
Suite 260
Grand Rapids, MI 49546
Phone
(616) 957-9237
Fax
(616) 957-1013
NPI assigned
Feb 17, 2006
Last updated
Feb 1, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601003816 MI Primary

Addresses

Primary practice location

1000 East Paris Ave SE
Suite 260
Grand Rapids, MI 49546

Mailing address

1000 East Paris Ave SE
Suite 260
Grand Rapids, MI 49546
Phone (616) 957-9237

Other names 1

  • Kathryn Joy Miedema Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100108000821 MI Practitioner - Physician Assistant 2860533197 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
West Michigan Endocrine, PLCGroup PAC ID 4385033711, 2 clinicians

Practice addresses (Care Compare)

5060 Cascade Rd SE
Suite C1
Grand Rapids, MI 49546-3808
Phone (616) 255-9521

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601003816MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bennett Institute for Urogynecology and Incontinence PC PastSince Jul 1, 2022 Accepting new patients
Inpatient Consultants of Michigan PC Past Accepting new patients

Interoperability endpoints

  • Direct secure messaging: kpleune85820@epic00.corewelldirect.org

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 5

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": "1140134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643673600000",
    "number": "1467426122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 EAST PARIS AVE SE",
            "address_2": "SUITE 260",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-957-9237",
            "fax_number": "616-957-1013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 EAST PARIS AVE SE",
            "address_2": "SUITE 260",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49546",
            "telephone_number": "616-957-9237",
            "fax_number": "616-957-1013"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PLEUNE",
        "first_name": "KATHRYN",
        "middle_name": "JOY",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-17",
        "last_updated": "2022-02-01",
        "certification_date": "2022-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601003816",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHRYN",
            "last_name": "MIEDEMA",
            "middle_name": "JOY",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.