Active NPI
Macenzie Jordyn Koning, AU.D.
- Audiologist
- Grand Rapids, MI
National Provider Identifier
1548797244
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Audiologist
- Practice address
- 751 Kenmoor Ave SE Ste B
Grand Rapids, MI 49546-2391 - Phone
- (616) 954-1895
- NPI assigned
- May 12, 2017
- 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 |
|---|---|---|---|---|
| Audiologist | 231H00000X | Primary |
Addresses
Primary practice location
751 Kenmoor Ave SE Ste B
Grand Rapids, MI 49546-2391
Mailing address
8308 Clarkland Dr SE
Alto, MI 49302-9412
Phone (616) 293-9970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1494547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1494547200000",
"number": "1548797244",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8308 CLARKLAND DR SE",
"city": "ALTO",
"state": "MI",
"postal_code": "493029412",
"telephone_number": "616-293-9970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "751 KENMOOR AVE SE STE B",
"city": "GRAND RAPIDS",
"state": "MI",
"postal_code": "495462391",
"telephone_number": "616-954-1895"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KONING",
"first_name": "MACENZIE",
"middle_name": "JORDYN",
"name_prefix": "Mrs.",
"credential": "AU.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-05-12",
"last_updated": "2017-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "231H00000X",
"taxonomy_group": "",
"desc": "Audiologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Rapids, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.