Jill Bultje, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301074566 Issued in MI

Practice address

1471 E Beltline Ave NE
Suite 201
Grand Rapids, MI 49525-4548

Phone

(616) 685-8620

Fax

(676) 447-7674

NPI assigned

May 17, 2006

Sex

Female

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 7

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: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Family Practice

Education

Michigan State University College of Human Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Advantage Health/Saint Mary'S Medical GroupGroup PAC ID 4082807961, 499 clinicians

Center for Physical Rehabilitation IncGroup PAC ID 6901717768, 352 clinicians

Center for Physical Rehabilitation and Therapy LPGroup PAC ID 0941513303, 365 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Health Saint Mary'S Hospital, Grand Rapids, MI, CCN 230059

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Advantage Health/Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1376862151
  Medicare reassignment Care Compare group NPD
• Center for Physical Rehabilitation and Therapy LP

  • Physical Therapy Clinic/Center
  • Grand Rapids, MI
  • NPI 1902288863
  Care Compare group
• Advantage Health Saint Mary'S Medical Group

  • Orthopaedic Surgery Physician
  • Byron Center, MI
  • NPI 1003515008
  NPD
• Advantage Health Saint Mary'S Medical Group

  • Multi-Specialty Clinic/Center
  • Grand Rapids, MI
  • NPI 1952340911
  NPD
• Advantage Health Physicians PC

  • Family Medicine Physician
  • Grand Rapids, MI
  • NPI 1386695252
  NPD (past)

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

• Saint Mary'S Health Services

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1639111057
  Care Compare affiliation

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

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245974400000",
    "number": "1568414241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 STATE ST SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495034328",
            "telephone_number": "616-685-1808",
            "fax_number": "616-685-1850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1471 E BELTLINE AVE NE",
            "address_2": "SUITE 201",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495254548",
            "telephone_number": "616-685-8620",
            "fax_number": "676-447-7674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULTJE",
        "first_name": "JILL",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-17",
        "last_updated": "2009-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301074566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4876996",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440310",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440347",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440338",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440300",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4440329",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4548162",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tnae Bullock
• Angela L Bultema, RDH
• Anna Bultema
• Katherine Bulthuis
• Lori Lee Bultinck, OTR
• Rebecca L Bultman, MD
• Shayla Bunch
• Lenuta Bunda
• Nicholas Bunda, MD
• Brenten Bunde-Schau

• Family Medicine Physician in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2009; 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.