David Jon Blystra

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301506520 Issued in MI

Practice address

904 Washington Ave Ste 210
Holland, MI 49423-7724

Phone

(616) 392-8035

NPI assigned

Apr 3, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

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

Specialty

Family Practice

Education

Michigan State University College of Human Medicine, 2019

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Holland Community HospitalGroup PAC ID 0446157291, 174 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Holland Hospital Hospital, Holland, MI, CCN 230072

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: david.blystra@holland.eclinicaldirectplus.com

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.

• Holland Community Hospital

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Holland, MI
  • NPI 1780888099
  Medicare reassignment Care Compare group NPD
• Holland Community Hospital

  • Family Medicine Physician
  • Holland, MI
  • NPI 1174800437
  NPD
• Holland Community Hospital

  • Family Medicine Physician
  • Hudsonville, MI
  • NPI 1952130585
  NPD
• Holland Community Hospital

  • Otolaryngology Physician
  • Holland, MI
  • NPI 1982910857
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Holland Community Hospital

  • General Acute Care Hospital
  • Holland, MI
  • NPI 1871672618
  Care Compare affiliation

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

{
    "created_epoch": "1554249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660003200000",
    "number": "1508328014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 WASHINGTON AVE STE 210",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237724",
            "telephone_number": "616-392-8035"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 WASHINGTON AVE STE 210",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494237724",
            "telephone_number": "616-392-8035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLYSTRA",
        "first_name": "DAVID",
        "middle_name": "JON",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-03",
        "last_updated": "2022-08-09",
        "certification_date": "2022-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301506520",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "9999999",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Jon Blauwkamp, D.C.
• Douglas A Bleyenburg, DDS
• Joseph R Blodgett, M.D.
• Brittney Bloomquist
• Eleanor Elizabeth Blouw, CRNA
• Tracy Ann Bobo, LMSW
• Kyle Boer, LMSW, CAADC
• Emily Boerman
• Jennifer Boerman
• Rachele Boerman

• Family Medicine Physician in Holland, MI
• Providers in Holland, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.