Jack a Dekkinga MD PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

JACK A DEKKINGA MD PC

Doing business as

West Michigan Dermatology

Practice address

3434 Rivertown Point CT SW
Grandville, MI 49418-3076

Phone

(616) 257-3344

Fax

(616) 257-1491

NPI assigned

Jul 20, 2006

Last updated

Jul 31, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Gina Charlene Ang, MDNPI 1396853966

Title

President

Phone

(616) 257-3344

Specialties & licenses 2

Addresses

Other identifiers 3

Other names 1

• West Michigan Dermatology Doing business as

Medicare fee-for-service enrollment

Enrolled in MI2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 74

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gina Charlene Ang, MD

  • MOHS-Micrographic Surgery Physician
  • Grandville, MI
  • NPI 1396853966

  Dermatology

  Medicare reassignment Care Compare group NPD Authorized official
• Bridget Anne Green, M.D,

  • Dermatology Physician
  • Rockford, MI
  • NPI 1356542500
  Medicare reassignment Care Compare group NPD
• Jayme Marie Heim, NP

  • Family Nurse Practitioner
  • Grandville, MI
  • NPI 1992912836

  Dermatology

  Medicare reassignment Care Compare group NPD
• Maia Kirsten Keller, MD

  • Dermatology Physician
  • Holland, MI
  • NPI 1124695671
  Medicare reassignment Care Compare group NPD
• Rachel Lynn Laarman, MD

  • Pediatric Dermatology Physician
  • Rockford, MI
  • NPI 1598908444
  Medicare reassignment Care Compare group NPD
• Brandon William McNally, M.D.

  • Dermatopathology Physician
  • Grandville, MI
  • NPI 1073740833

  Multi-Specialty

  Medicare reassignment Care Compare group NPD
• Luke C. Nicholas, MD

  • MOHS-Micrographic Surgery Physician
  • Rockford, MI
  • NPI 1467509620

  Dermatology

  Medicare reassignment Care Compare group NPD
• Chelsea St. Claire, MD

  • MOHS-Micrographic Surgery Physician
  • Okemos, MI
  • NPI 1700371283

  Dermatology

  Medicare reassignment Care Compare group NPD
• Amy Marie Strikwerda, M.D.

  • Dermatology Physician
  • Grand Rapids, MI
  • NPI 1912265521
  Medicare reassignment Care Compare group NPD
• Brooke Erin Vasicek, M.D.

  • Dermatology Physician
  • Rockford, MI
  • NPI 1619326550
  Medicare reassignment Care Compare group NPD
• Juan Gabriel Vasquez, M.D.

  • Dermatopathology Physician
  • Grandville, MI
  • NPI 1093981607

  Dermatology

  Medicare reassignment Care Compare group NPD
• Douglas A Winstanley, D.O.

  • MOHS-Micrographic Surgery Physician
  • Grandville, MI
  • NPI 1609855402

  Dermatology

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722384000000",
    "number": "1609896034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3434 RIVERTOWN POINT CT SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494183076",
            "telephone_number": "616-257-3344",
            "fax_number": "616-257-1491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3434 RIVERTOWN POINT CT SW",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494183076",
            "telephone_number": "616-257-3344",
            "fax_number": "616-257-1491"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3290 N Wellness Dr Ste 240",
            "address_purpose": "LOCATION",
            "city": "Holland",
            "state": "MI",
            "postal_code": "494247261",
            "country_code": "US",
            "telephone_number": "616-395-9379",
            "fax_number": "616-820-1457",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6150 Northland Drive",
            "address_purpose": "LOCATION",
            "city": "Rockford",
            "state": "MI",
            "postal_code": "49341",
            "country_code": "US",
            "telephone_number": "616-942-9343",
            "fax_number": "616-942-2538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "JACK A DEKKINGA MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "ANG",
        "authorized_official_first_name": "GINA",
        "authorized_official_middle_name": "CHARLENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "616-257-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301039679",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP NUMBER",
            "identifier": "0N86210",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE  RAILROAD GROUP",
            "identifier": "CI2832",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MICHIGAN",
            "identifier": "070D16223",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Michigan Dermatology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dermatology Physician in Grandville, MI
• Providers in Grandville, MI by specialty
• Dermatology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.