Individual provider Active NPI

Marie Vander Linde, MD

  • Family Medicine Physician
  • Kentwood, MI
National Provider Identifier
1467456129
Registry record updated Sep 19, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301407224 Issued in MI
Practice address
2080 44TH St SE
Kentwood, MI 49508-5299
Phone
(616) 685-8100
Fax
(616) 455-5052
NPI assigned
Jun 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301407224 MI Primary

Addresses

Primary practice location

2080 44TH St SE
Kentwood, MI 49508-5299

Mailing address

1900 44TH St SE
Kentwood, MI 49508-5008

Other identifiers 1

IdentifierTypeStateIssuer
4334756MedicaidMI

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100115000698 MI Practitioner - Family Practice 7911049796 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Jun 8, 2017 Accepting new patients
Advantage Health Saint Mary'S Medical Group CurrentSince Jun 8, 2017 Accepting new patients
Spectrum Health Primary Care Partners Current Accepting new patients

Locations

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

2249 Wealthy St SE
Ste 110
Grand Rapids, MI 49506
Phone (616) 391-4600

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

2080 44th St SE
Kentwood, MI 49508
Phone (616) 685-8100

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

4540 Kalamazoo Ave SE
Kentwood, MI 49508
Phone (616) 281-0666

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.

NPI Registry JSON

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

{
    "created_epoch": "1118361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505779200000",
    "number": "1467456129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085008"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2080 44TH ST SE",
            "city": "KENTWOOD",
            "state": "MI",
            "postal_code": "495085299",
            "telephone_number": "616-685-8100",
            "fax_number": "616-455-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDER LINDE",
        "first_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-10",
        "last_updated": "2017-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301407224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4334756",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Kentwood, MI

Sources for this page

Verify at the official NPI Registry.