Active NPI
Diane Anderson, NP
- Nurse Practitioner
- Kentwood, MI
National Provider Identifier
1548283062
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 4704101913
- Practice address
- 1676 Viewpond Dr SE
Suite 100a
Kentwood, MI 49508-4994 - Phone
- (616) 455-9450
- Fax
- (616) 455-5221
- NPI assigned
- Jul 25, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 4704101913 | MI | Primary |
Addresses
Primary practice location
1676 Viewpond Dr SE
Suite 100a
Kentwood, MI 49508-4994
Mailing address
1676 Viewpond Dr SE
Suite 100a
Kentwood, MI 49508-4994
Phone (616) 455-9450
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4849371 | Medicaid | MI | |
| 1598853608 | Other | GROUP NPI - JOHN N CAMPBELL MD PC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Metropolitan Hospital | Past | Accepting new patients |
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 and National Provider Directory roles.
-
dba Metro Health Hospital
- General Acute Care Hospital
- Wyoming, MI
- NPI 1619923919
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153785600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289779200000",
"number": "1548283062",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1676 VIEWPOND DR SE",
"address_2": "SUITE 100A",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495084994",
"telephone_number": "616-455-9450",
"fax_number": "616-455-9450"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1676 VIEWPOND DR SE",
"address_2": "SUITE 100A",
"city": "KENTWOOD",
"state": "MI",
"postal_code": "495084994",
"telephone_number": "616-455-9450",
"fax_number": "616-455-5221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ANDERSON",
"first_name": "DIANE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-25",
"last_updated": "2010-11-15",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MI",
"license": "4704101913",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4849371",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI - JOHN N CAMPBELL MD PC",
"identifier": "1598853608",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Kentwood, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.