Individual provider Active NPI

Timothy Amborski, NP

  • Nurse Practitioner
  • Benton Harbor, MI
National Provider Identifier
1629578703
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
4704244236 Issued in MI
Practice address
800 M 139
Benton Harbor, MI 49022-3881
Phone
(855) 869-6900
Fax
(269) 927-4208
NPI assigned
Feb 15, 2018
Last updated
Mar 15, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4704244236 MI Primary

Addresses

Primary practice location

800 M 139
Benton Harbor, MI 49022-3881

Mailing address

800 M 139
Benton Harbor, MI 49022-3881
Phone (855) 869-6900

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
I20180601001293 MI Practitioner - Nurse Practitioner 3375808983 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Street Services IncGroup PAC ID 6800707647, 58 clinicians

Practice addresses (Care Compare)

550 Cherry St SE
Grand Rapids, MI 49503-4748
Phone (616) 235-7272

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704244236MIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Intercare Community Health Network CurrentSince Sep 13, 2022 Accepting new patients
Intercare Community Health Network CurrentSince Sep 13, 2022 Accepting new patients
Pine Rest Christian Mental Health Services CurrentSince Jul 1, 2021 Accepting new patients
Pine Rest Christian Mental Health Services Nurse Practitioner CurrentSince Jul 1, 2021 Accepting new patients
Cherry Street Services, Inc. CurrentSince May 1, 2025 Accepting new patients
Cherry Street Services, Inc CurrentSince May 1, 2025 Accepting new patients
Cherry Street Health Services Past Accepting new patients

Locations

50 Industrial Park Rd
Bangor, MI 49013
Phone (269) 427-7937

800 M 139
Benton Harbor, MI 49022
Phone (269) 927-5400

100 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 965-8209

550 Cherry St SE
Grand Rapids, MI 49503
Phone (616) 235-7272

300 68th St SE
Wyoming, MI 49548
Phone (616) 455-5000

Interoperability endpoints

  • Direct secure messaging: timothy.amborski.p1@direct.cherryhealth.nextgenshare.com

Organizations & group practices 7

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.

Hospital & facility affiliations 3

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": "1518652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1629578703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490223881",
            "telephone_number": "855-869-6900",
            "fax_number": "269-927-4208"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 M 139",
            "city": "BENTON HARBOR",
            "state": "MI",
            "postal_code": "490223881",
            "telephone_number": "855-869-6900",
            "fax_number": "269-927-4208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBORSKI",
        "first_name": "TIMOTHY",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-02-15",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "4704244236",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Benton Harbor, MI

Sources for this page

Verify at the official NPI Registry.