Michael Kooistra Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01045333A Issued in IN

Practice address

1306 E 7TH St Ste a
Auburn, IN 46706-2537

Phone

(260) 925-1255

Fax

(260) 925-1256

NPI assigned

Jul 14, 2005

Last updated

Jan 2, 2024By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in IN, OH2 enrollments

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 2

Specialty

Family Practice

Education

Indiana University School of Medicine, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Parkview Health System IncGroup PAC ID 2163336967, 1,350 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohioans Home Healthcare, Inc Home health agency, Perrysburg, OH, CCN 368247
• Parkview Dekalb Hospital Hospital, Auburn, IN, CCN 150045
• Community Hospitals and Wellness Centers Hospital, Bryan, OH, CCN 360121
• Parkview Regional Medical Center Hospital, Fort Wayne, IN, CCN 150021
• Community Hospitals and Wellness Centers Hospital, Montpelier, OH, CCN 361327
• Cameron Health Hospital, Angola, IN, CCN 151315

Merit-based Incentive Payment System (MIPS)

Final score

83.53 of 100Reported as group

Quality

70

Promoting interoperability

100

Improvement activities

40

Cost

75.11

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mkooistra4280@direct.parkviewexchange.com

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.

• Parkview Health System Inc

  dba Parkview Physicians Group

  • Family Medicine Physician
  • Fort Wayne, IN
  • NPI 1932130952
  Medicare reassignment Care Compare group NPD
• Dekalb Memorial Hospital, Inc

  dba Parkview Dekalb Hospital

  • General Acute Care Hospital
  • Auburn, IN
  • NPI 1902897937
  NPD
• Community Memorial Hospital

  dba Edgerton Family Health Center

  • Rural Health Clinic/Center
  • Edgerton, OH
  • NPI 1336632280
  NPD (past)
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

• Cameron Memorial Community Hospital, Inc.

  • Critical Access Hospital
  • Angola, IN
  • NPI 1386683316
  Care Compare affiliation
• Dekalb Memorial Hospital, Inc

  dba Parkview Dekalb Hospital

  • General Acute Care Hospital
  • Auburn, IN
  • NPI 1902897937
  Care Compare affiliation
• Parkview Hospital, Inc.

  dba Parkview Regional Medical Center

  • General Acute Care Hospital
  • Fort Wayne, IN
  • NPI 1366407603
  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • Critical Access Hospital
  • Montpelier, OH
  • NPI 1275575227
  Care Compare affiliation
• Community Hospitals and Wellness Centers

  • General Acute Care Hospital
  • Bryan, OH
  • NPI 1962458521
  Care Compare affiliation
• Ohioans Home Healthcare, Inc

  • Home Health Agency
  • Perrysburg, OH
  • NPI 1093836546
  Care Compare affiliation

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

{
    "created_epoch": "1121299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704153600000",
    "number": "1508864380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11109 PARKVIEW PLAZA DR # 117",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468451701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1306 E 7TH ST STE A",
            "city": "AUBURN",
            "state": "IN",
            "postal_code": "467062537",
            "telephone_number": "260-925-1255",
            "fax_number": "260-925-1256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOISTRA",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-14",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01045333A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200115800",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01045333A",
            "state": "IN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mkooistra4280@Direct.Parkviewexchange.com",
            "affiliation": "N",
            "address_1": "1306 E 7th St Ste A",
            "city": "Auburn",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467062537",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1306 E 7th St Ste A",
            "city": "Auburn",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467062537",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicprod-mobile.parkview.com/FHIR/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "1306 E 7th St Ste A",
            "city": "Auburn",
            "state": "IN",
            "country_code": "US",
            "postal_code": "467062537",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Crystal Nicole Kennedy, NP
• Shirley Kisor, RPH
• Amy Kleeman, PT
• Lindsey Koble
• Kalyan Kondeti
• Jennifer Lynn Kracium, LCSW
• Samantha J Krider, LCSW
• Kroger Limited Partnership I (Kroger Pharmacy)
• Kroger Limited Partnership I (Scotts Pharmacy)
• Erica L Kueber, N.P.

• Family Medicine Physician in Auburn, IN
• Providers in Auburn, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; 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.