Robert J Hiddema, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901012500 Issued in MI

Practice address

555 Broadway
South Haven, MI 49090

Phone

(269) 323-2889

Fax

(269) 639-1264

NPI assigned

Oct 24, 2006

Last updated

Dec 29, 2009By 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 1

Addresses

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: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: robert.hiddema@ichn.eclinicaldirectplus.com

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.

• Intercare Community Health Network

  • Federally Qualified Health Center (FQHC)
  • Bangor, MI
  • NPI 1326058512
  Medicare reassignment NPD
• Intercare Community Health Network

  dba InterCare Child and Adolescent Behavioral Health Center

  • Federally Qualified Health Center (FQHC)
  • Eau Claire, MI
  • NPI 1336701119
  NPD

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

{
    "created_epoch": "1161648000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1262044800000",
    "number": "1588748198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 BROADWAY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "49090",
            "telephone_number": "269-323-2889",
            "fax_number": "269-639-1264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 BROADWAY",
            "city": "SOUTH HAVEN",
            "state": "MI",
            "postal_code": "49090",
            "telephone_number": "269-323-2889",
            "fax_number": "269-639-1264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIDDEMA",
        "first_name": "ROBERT",
        "middle_name": "J",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-24",
        "last_updated": "2009-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012500",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in South Haven, MI
• Providers in South Haven, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.