Individual provider Active NPI

Kevin Fitzgerald, PMHNP-BC

  • Psychiatric/Mental Health Nurse Practitioner
  • Kalamazoo, MI
National Provider Identifier
1487152633
Registry record updated Feb 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
4704305891 Issued in MI
Practice address
610 S Burdick St
Kalamazoo, MI 49007-5221
Phone
(269) 381-3700
Fax
(269) 381-3810
NPI assigned
Jan 23, 2018
Last updated
Feb 20, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 4704305891 MI Primary
Registered Nurse 163W00000X 4704305891 MI

Addresses

Primary practice location

610 S Burdick St
Kalamazoo, MI 49007-5221

Mailing address

610 S Burdick St
Kalamazoo, MI 49007-5221
Phone (269) 381-3700

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
I20190226003457 MI Practitioner - Nurse Practitioner 0749529386 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Health PartnersGroup PAC ID 1456430016, 65 clinicians

Practice addresses (Care Compare)

125 E Southern Ave
Suite 120
Muskegon, MI 49442-5042
Phone (231) 672-4950

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advantage Health Saint Mary's Medical Group CurrentSince Feb 20, 2019 Accepting new patients
Mercy Health Partners CurrentSince May 15, 2025 Accepting new patients
Mercy Health Partners CurrentSince May 15, 2025 Accepting new patients
Advantage Health/Saint Mary's Medical Group Current Accepting new patients
Advantage Health Saint Mary's Medical Group CurrentSince Feb 20, 2019 Accepting new patients

Locations

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

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

125 E Southern Ave
#120
Muskegon, MI 49442
Phone (231) 672-4950

71 Bevier St
Shelby, MI 49455
Phone (231) 861-2172

Organizations & group practices 5

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": "1516665600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550620800000",
    "number": "1487152633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 S BURDICK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075221",
            "telephone_number": "269-381-3700",
            "fax_number": "269-381-3810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 S BURDICK ST",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075221",
            "telephone_number": "269-381-3700",
            "fax_number": "269-381-3810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITZGERALD",
        "first_name": "KEVIN",
        "credential": "PMHNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-01-23",
        "last_updated": "2019-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MI",
            "license": "4704305891",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704305891",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kalamazoo, MI

Sources for this page

Verify at the official NPI Registry.