Jack A Kooienga, APRN

Primary specialty

Acute Care Nurse PractitionerTaxonomy code 363LA2100X

License

APRN11012762 Issued in FL

Practice address

5900 Byron Center Ave SW
Wyoming, MI 49519-9606

Phone

(616) 252-7200

Fax

(616) 252-7830

NPI assigned

Sep 7, 2012

Last updated

Aug 9, 2021By 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 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI, FL, WI3 enrollments

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 3

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Intensive Care Consortium IncGroup PAC ID 0244269413, 485 clinicians

Wexford Physician Services PCGroup PAC ID 3072024330, 39 clinicians

Florida Hospital Medical Group IncGroup PAC ID 0749186153, 1,735 clinicians

Otsego Physician Services PCGroup PAC ID 7416468954, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• HCA Florida Lake City Hospital Hospital, Lake City, FL, CCN 100156
• Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081
• Adventhealth Lake Wales Hospital, Lake Wales, FL, CCN 100099

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Quality

96.63

Improvement activities

40

Cost

81.81

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Networks

• Optimum HealthCare HMO Network
• Freedom Health HMO Network

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.

• Florida Hospital Medical Group Inc

  dba AdventHealth Medical Group

  • Family Medicine Physician
  • Orlando, FL
  • NPI 1225034234
  Medicare reassignment Care Compare group NPD
• Intensive Care Consortium Inc

  • Specialist
  • Aventura, FL
  • NPI 1629019062
  Medicare reassignment Care Compare group NPD
• Otsego Physician Services PC

  • Internal Medicine Physician
  • Gaylord, MI
  • NPI 1346054236
  Medicare reassignment Care Compare group
• Wexford Physician Services PC

  • Hospitalist Physician
  • Cadillac, MI
  • NPI 1649084260
  Medicare reassignment Care Compare group
• Michigan Emergency Physicians, LLP

  • Emergency Medicine Physician
  • Three Rivers, MI
  • NPI 1205075074
  Medicare reassignment NPD
• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077
  Medicare reassignment NPD
• North Michigan Physician Services PC

  • Hospitalist Physician
  • Charlevoix, MI
  • NPI 1972314821
  Medicare reassignment
• Michigan Emergency Physicians LLP

  • Emergency Medicine Physician
  • Hillsdale, MI
  • NPI 1770820953
  NPD
• Florida Hospital Medical Group Inc

  dba Rothman Orthopaedics AdventHealth Medical Group at Minneola

  • Prosthetic/Orthotic Supplier
  • Minneola, FL
  • NPI 1285591545
  NPD
• Metropolitan Hospital

  dba Metro Health Community Clinic

  • Family Medicine Physician
  • Wyoming, MI
  • NPI 1114947538
  NPD (past)
• Metropolitan Hospital

  dba Metro Health Hospital

  • Anatomic Pathology & Clinical Pathology Physician
  • Wyoming, MI
  • NPI 1336182542
  NPD (past)

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

• Munson Healthcare Cadillac

  dba Munson Healthcare Cadillac Physician Network

  • Family Medicine Physician
  • Cadillac, MI
  • NPI 1487051611

  Hospital

  Care Compare affiliation
• Munson Healthcare Cadillac

  • General Acute Care Hospital
  • Cadillac, MI
  • NPI 1841696754
  Care Compare affiliation
• Adventhealth Polk South Inc

  dba AdventHealth Lake Wales

  • General Acute Care Hospital
  • Lake Wales, FL
  • NPI 1053972760
  Care Compare affiliation
• Notami Hospitals of Florida Inc

  dba HCA Florida Lake City Hospital

  • General Acute Care Hospital
  • Lake City, FL
  • NPI 1992751879
  Care Compare affiliation

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

{
    "created_epoch": "1346976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1628467200000",
    "number": "1518216308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "985 GEZON PKWY SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495099563",
            "telephone_number": "616-252-4655",
            "fax_number": "616-252-0103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5900 BYRON CENTER AVE SW",
            "city": "WYOMING",
            "state": "MI",
            "postal_code": "495199606",
            "telephone_number": "616-252-7200",
            "fax_number": "616-252-7830"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 E Rollins St",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328031248",
            "country_code": "US",
            "telephone_number": "407-303-7283",
            "fax_number": "407-303-0347",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOOIENGA",
        "first_name": "JACK",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-09-07",
        "last_updated": "2021-08-09",
        "certification_date": "2021-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "FL",
            "license": "APRN11012762",
            "primary": true
        },
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "MI",
            "license": "4704218318",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110773300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joshua Kolman, PHARM.D.
• Margaret Anne Konwinski, NP
• Joshua Konynenbelt, D.C., M.S.
• Lisa Konynenbelt, D.C.
• Emily Hope Kooienga
• Kooistra Chiropractic Clinic PLLC
• Charles Scott Kooistra, DC
• Gerald B Kooistra, DC
• Jared Lee Kooistra, D.C.
• Laura Kooy

• Acute Care Nurse Practitioner in Wyoming, MI
• Providers in Wyoming, MI by specialty
• Acute Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2021; 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.