Individual provider Active NPI

Claudia Allyn Gates, FNP-C

  • Family Nurse Practitioner
  • Holland, MI
National Provider Identifier
1528654043
Registry record updated Oct 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704375133 Issued in MI
Practice address
382 N 120TH Ave
Holland, MI 49424-2169
Phone
(616) 796-3414
NPI assigned
Dec 18, 2020
Last updated
Oct 13, 2021By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704375133 MI Primary
Registered Nurse 163W00000X 460458 OH

Addresses

Primary practice location

382 N 120TH Ave
Holland, MI 49424-2169

Mailing address

382 N 120TH Ave
Holland, MI 49424-2169
Phone (616) 396-6516

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
I20211019002662 MI Practitioner - Nurse Practitioner 4981092228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

382 N 120TH Ave
Holland, MI 49424-2169

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
460458OHMDRegistered Nurse
4704375133MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lakewood Family Medicine PLC CurrentSince Aug 30, 2021 Accepting new patients

Locations

382 N 120th Ave
Holland, MI 49424
Phone (616) 396-6516

Organizations & group practices 1

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": "1608249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634083200000",
    "number": "1528654043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "382 N 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242169",
            "telephone_number": "616-396-6516",
            "fax_number": "616-396-2513"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "382 N 120TH AVE",
            "city": "HOLLAND",
            "state": "MI",
            "postal_code": "494242169",
            "telephone_number": "616-796-3414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATES",
        "first_name": "CLAUDIA",
        "middle_name": "ALLYN",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-18",
        "last_updated": "2021-10-13",
        "certification_date": "2021-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704375133",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "460458",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holland, MI

Sources for this page

Verify at the official NPI Registry.