Individual provider Active NPI

Ann Marie Wiltshire, FNP

  • Family Nurse Practitioner
  • Grand Rapids, MI
National Provider Identifier
1629353974
Registry record updated Jan 9, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704285662 Issued in MI
Practice address
4100 Lake Dr SE Ste B01
Grand Rapids, MI 49546-8292
Phone
(616) 267-7400
NPI assigned
Oct 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704285662 MI Primary

Addresses

Primary practice location

4100 Lake Dr SE Ste B01
Grand Rapids, MI 49546-8292

Mailing address

100 Michigan St NE # Mc845
Grand Rapids, MI 49503-2560

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141106001819 MI Practitioner - Nurse Practitioner 2163696543 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4069 Lake Dr SE
Grand Rapids, MI 49546-8816

4100 Lake Dr SE
Grand Rapids, MI 49546-8292

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

8333 Felch St
Zeeland, MI 49464-2609

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners CurrentSince Jan 9, 2023 Accepting new patients
Advantage Health/Saint Mary'S Medical Group CurrentSince Nov 1, 2014 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Jan 9, 2023 Accepting new patients
Advantage Health Saint Mary'S Medical Group Nurse Practitioner CurrentSince Nov 1, 2014 Accepting new patients
Family Medicine Specialists, PC PastSince Nov 1, 2019 Accepting new patients

Locations

10047 Crossroad Ct SE
Caledonia, MI 49316
Phone (616) 685-8850

15100 Whittaker Way
Grand Haven, MI 49417
Phone (616) 935-6200

4100 Lake Dr SE
Ste B01
Grand Rapids, MI 49546
Phone (616) 267-7400

100 Michigan St NE
#845
Grand Rapids, MI 49503
Phone (616) 391-8242

4100 Lake Dr SE
Grand Rapids, MI 49546
Phone (616) 267-7400

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

933 3 Mile Rd NW
Ste 210
Walker, MI 49544
Phone (616) 685-7985

8333 Felch St
Ste 300
Zeeland, MI 49464
Phone (616) 267-9823

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/14507/brand/1/csg/1/fhir/r4
  • Direct secure messaging: awiltshire242156@epic00.corewelldirect.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1318982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673222400000",
    "number": "1629353974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MICHIGAN ST NE # MC845",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495032560"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 LAKE DR SE STE B01",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468292",
            "telephone_number": "616-267-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILTSHIRE",
        "first_name": "ANN",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-19",
        "last_updated": "2023-01-09",
        "certification_date": "2023-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704285662",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

Verify at the official NPI Registry.